Abstract: TH-PO315
Impact of Comprehensive Predialysis Education (CoPE) on Rural Veterans' Informed Kidney Replacement Therapy (KRT) Selection
Session Information
- Hemodialysis and Frequent Dialysis - 1
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Wadhwa, Anuradha, Edward Hines Junior VA Hospital, Hines, Illinois, United States
- Subhash, Shobha, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
- Pearce, Kailyn, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
- Scheiffele, Grant D., VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
- Ye, Xiangyang, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
- Agarwal, Adhish, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
- Shukla, Ashutosh M., VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
Background
CoPE has a significant impact on patients’ informed KRT modality choice; however, the prevalent state of informed dialysis selection patterns and the impact of CoPE among rural Veterans is unknown.
Methods
We conducted a prospective cohort study across five Veteran Healthcare systems in FL, UT, and IL to evaluate the impact of CoPE on rural Veterans’ KRT decision-making. Informed modality selection was defined as KRT modality selection with more than 60% confidence on a 0-100%, 5-point Likert scale. Differences in ability to make a modality selection were assessed pre- and post-CoPE by various patient-level characteristics.
Results
Of the 218 Veterans with advanced CKD who received CoPE during fiscal years 2023 and 2024, only 9.0% reported receiving prior CoPE. Pre-CoPE, fewer than half (38.5%) of patients endorsed a hypothetical KRT modality; however, post-CoPE nearly all (94.5%) did. Home dialysis KRT preferences additionally rose significantly from 21% pre-CoPE to 82% post-CoPE (p=0.04, Table 1). Optimal health literacy score, advanced (Stage 5) CKD, and hypertension comorbidity were each independently associated with higher odds of KRT selection pre-intervention; however, post-CoPE KRT modality endorsement differed significantly only by CKD/ESRD awareness measures (p<0.05).
Conclusion
Our study shows significant deficits in access to CoPE and poor baseline state of dialysis decision-making among rural Veterans with advanced CKD. Substantial improvement both in Veterans’ confidence in modality selection and selection of home dialysis KRT methods were noted after provision of education. Importantly, CoPE appeared to attenuate patient-level differences in ability to endorse a KRT modality preference in our sample. System-wide assessment and implementation of CoPE can improve Veteran confidence in dialysis selection and home dialysis utilization.
KRT selections pre- vs. post-CoPE
| Patient Selection | Pre-CoPE | Post-CoPE |
| Peritoneal dialysis | 16 (7.3%) | 160 (73.4%) |
| Home hemodialysis | 30 (13.8%) | 19 (8.7%) |
| In-center hemodialysis | 17 (7.8%) | 18 (8.3%) |
| Conservative care | 21 (10.0%) | 9 (4.1%) |
| Informed KRT Selection | ||
| Yes (61 – 100% confident) | 34 (15.6%) | 187 (85.8%) |
| No (0 – 60% confident) | 50 (22.9%) | 19 (8.7%) |
Funding
- Veterans Affairs Support