Patient Preparation Linked to Improved Survival in ESRD

A community kidney disease screening and education program improves patient preparation for ESRD, thus leading to increased survival, suggests a report in Kidney International.

The study included 595 adult patients who experienced ESRD after attending the National Kidney Foundation’s Kidney Early Evaluation Program (KEEP), a free, community-based program to identify patients at increased risk of kidney disease and to encourage follow-up care. These patients were matched for demographic and clinical characteristics with non-KEEP patients. The researchers hypothesized that KEEP patients would be better prepared for ESRD and that this would be associated with lower ESRD mortality.

Several aspects of ESRD preparation were better in the KEEP group. Significant differences (KEEP group versus non-KEEP group) included receiving a nephrologist’s care before the development of ESRD, 76.0 versus 69.3 percent; peritoneal dialysis, 10.3 versus 6.4 percent; preemptive waitlisting for transplantation, 24.2 versus 17.1 percent; and transplantation, 9.7 versus 6.4 percent. The rates of permanent vascular access were similar between groups: 23.4 versus 20.1 percent.

A median of 1.6 years after the onset of ESRD, there were 175 deaths in the KEEP group versus 1037 in the comparison group: hazard ratio 0.80. The association between KEEP participation and survival remained significant in a propensity score model but became nonsignificant after adjustment for indicators of ESRD preparation.

Suboptimal preparation for ESRD may contribute to high mortality in a patient’s first year of dialysis and to excess costs of ESRD care. This study finds that KEEP participants are better prepared for ESRD and that indicators of preparation are associated with better survival during dialysis. The results “highlight opportunities to improve pre-ESRD care by reaching patients outside of the traditional health-care setting,” the researchers write [Kurella Tamura M, et al. Educational programs improve the preparation for dialysis and survival of patients with chronic kidney disease. Kidney Int 2014; 85:686–692].