‘Critical gap’ exists between recommended, prevalent nephrology practices


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Key takeaways:

  • Overall, 92.2% of patients with advanced CKD had basic awareness of kidney disease.
  • Additionally, 38.5% of the cohort were aware of the severity of the condition.

A “critical gap” between recommended and commonly used nephrology practices, including kidney replacement therapy-directed education, exists, according to a published study.

“Clinical guidelines recommend patients’ self-selection of [kidney replacement therapy] KRT modality through a shared decision-making process, which at the minimum, requires pre-dialysis nephrology care and KRT-directed comprehensive pre-kidney failure patient education (CoPE),” Gajapathiraju Chamarthi, MD, of the University of Florida, wrote with colleagues. “The current state of these essential services among Americans with advanced (stages 4 and 5) chronic kidney disease (CKD) and their informed preferences for home dialysis are unknown.”



Photo of a patient in a hospital bed

Overall, 92.2% of patients with advanced CKD had basic awareness of kidney disease. Image: Adobe Stock.

Researchers launched a community-based, cross-sectional study of a regional Veteran Healthcare System from 2020 to 2021. Veterans with advanced CKD, defined as an eGFR below 30 mL/min/1.73 m2, were selected for the needs-assessment evaluation.

Of the 928 patients with advanced CKD, researchers invited 30.9% to needs-assessment evaluations. Of the 218 who responded (76% of invited cohort), 81.6% were getting nephrology care and 43.6% received care from non-Veterans Affairs providers.

Researchers found 92.2% of patients with advanced CKD had basic awareness of kidney disease and 38.5% were aware of the severity of the condition. Additionally, 46.8% of patients reported having KRT-directed education during clinical care, with 21.1% getting targeted comprehensive pre-kidney failure patient education classes needed to make an informed KRT selection.

“Overall, awareness of CKD and its severity, and receipt of KRT-directed education were significantly higher among veterans with nephrology care, compared to those without,” the researchers wrote. They wrote that 74.3% of patients were interested in comprehensive pre-kidney failure patient services.

Of the 61 patients who provided KRT preferences, 73.8% were unable to choose a modality regardless of ongoing nephrology care. Overall, 13% of veterans reported feeling confident in the selection of home KRT modalities.

“Our results further identify significant deficits contributing this poor decision-making state and support recent calls for provider and policy-level changes to facilitate universal provision of KRT-directed education, preferably CoPE for all patients with advanced CKD,” the researchers wrote.

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