Education Program Helps Patients Make Modality Decisions

Orlando—In the United States, end-stage renal disease (ESRD) represents a burden to public health and increases pressure on healthcare costs. Data from 2014 identified approximately 680,000 prevalent cases of ESRD in the United States; up to 38% of incident patients did not receive care from a nephrologist prior to renal replacement therapy initiation.

Percentages of treatment modalities in the United States were hemodialysis 87.9%, peritoneal dialysis 9.3%, and kidney transplantation 2.6%. In comparison, in New Zealand, the percentages were 55.6% hemodialysis, 39.8% peritoneal dialysis, and 4.6% transplantation; in Hong Kong, they were 83.1% peritoneal dialysis, 13.9% hemodialysis, and 3% transplantation.

Costs for treatment for ESRD per patient per year in US Medicare 2014 were $32,586 for transplantation, $73,612 for peritoneal dialysis, and $87,638 for hemodialysis.

Currently, there is no standardized approach to patient education regarding options for ESRD treatment. Patients may make modality decisions too late to allow for selection of the best treatment, resulting in possible higher costs and higher morbidity at initiation of treatment. According to Anna Malkina, MD, and colleagues at Cricket Health Inc., lack of patient education results in missed opportunities to increase rates of home dialysis therapies and kidney transplantation among eligible patients.

Cricket Health has developed a technology-enabled program designed to educate patients with advanced chronic kidney disease (CKD) regarding options for treatment of ESRD. The program is conducted online and offers a supportive environment for patients to become familiar with the available options. The researchers designed a pilot prospective implementation program to assess the feasibility of offering the platform to patients. The pilot also aimed to evaluate patient choice of modality following completion of the program. Results to date were reported during a poster session at the NKF 2017 Spring Clinical Meetings in a poster titled Technology-Enabled Education on ESRD Treatment Options via Integrated Patient and Provided Online Community.

The pilot program included 27 patients with CKD stages 3b, 4, and 5 (estimated glomerular filtration rate <45 mL/min/1.73 m2) from four nephrology practices in California. Inclusion criteria were age >18 years, fluency in English, and access to an internet-connected personal computer or mobile device. Of the 27 patients, five are currently involved in the program, 19 have competed the program and have made a modality decision, and three have completed the program but have not made a modality decision. Average age of the patients is 62.5 years, 19 are male, seven accessed the program on a mobile device, and 20 utilized a laptop or desktop computer.

Of the 19 who have completed the program and made a modality decision, 15 chose peritoneal dialysis (79%), two chose home dialysis (10.5%), and two chose in-center hemodialysis (10.5%). The average number of days to making a decision was 33.6, the average number of videos watched was 8.3, the average number of frequently asked questions read was 56.6, the average number of chat messages sent was 14.4, 18 patients expressed interest in transplantation, and none chose palliative care as a treatment modality.

In their conclusions, the researchers said, “The majority of participants who completed the program decided on home modality for treatment of ESRD and expressed interest in referral for kidney transplant evaluation. The pilot program suggests increased update of home-based ESRD treatment modalities, with potential significant impact on healthcare costs.”

Source: Malkina A, Blanco B, Rajan A, Kin V, et al. Technology-enabled education on ESRD treatment options via integrated patient and provided online community. Poster presented at the National Kidney Foundation 2017 Spring Clinical Meetings, April 19-22, 2017, Orlando, Florida. Cricket Health provided support for this program.