NephJC: Educational programs improve the preparation for dialysis and survival of patients with chronic kidney disease.
Live TweetChat: April 29th at 9PM Eastern
This is an observational study regarding the NKF-funded KEEP program. Briefly, KEEP (Kidney Early Evaluation Program) is a national, community based screening and education program launched in August 2000. KEEP is a screening program that identifies people at high risk of kidney disease, and encourages them to follow-up with kidney focused preventative care. High risk is defined as:
- Self-reported history of diabetes or hypertension
- First degree relative with hypertension, diabetes or kidney disease
In addition to the personal and family history, participants have a serum creatinine and urine albumin:creatinine ratio checked. They then meet a physician and review their risk factors and discuss possible interventions.
For each participant, the final step is a letter describing test the results, the individuals presense or risk of future kidney disease and a personalized clinical action plan for treating CKD. This is sent to the participant and her doctor.
Patients who participated in KEEP and subsequently developed ESRD made up the intervention arm (N = 595). For the comparator the investigators used the USRDS database to identify incident ESRD patients who started dialysis during the same time period and who lived in the same zip-code. Propensity score matching was used (in a ratio of 5 controls for each KEEP participant) to identify 2975 non-KEEP control patients.
The baseline demographics (table 1) do show that the initial USRDS sample of 290,252 who started dialysis during that period were different in many ways from the KEEP participants; after the propensity score matching though, this sample was whittled down to a fairly comparable cohort with no significant imbalances. Amongst the results (Table 2), the KEEPers were:
- More likely to have seen a nephrologist (76% vs 69%)
- More likely to have been placed on the transplant waiting list before ESRD (24% vs 17%)
- More likely to have undergone transplantation (10% vs 6%)
- More likely to use peritoneal dialysis (10% vs 6%)
There were also some other interesting trends that did not reach statistical significance, KEEPers were more likely to:
- Use an arteriovenous fistula or graft (23% vs 20%)
- Have a mature or maturing AVF/AVG at first dialysis (44% vs 40%)
The most important finding was that mortality was lower (HR 0.80, 95% CI 0.68 — 0.94), though this was attenuated after adjustment (table 3).
The results of this study are extremely interesting for the nephrology community as we have struggled with improving the outcomes in our patients. As the accompanying editorial remarks,
this article “brings optimism and fresh air ..to the value of screening.. and preventive strategies.”
So now, please go ahead, read the article and start tweeting. We would love to have you join us for our live tweetchat 9 pm EST Tuesday April 29th. Please use the hashtag #NephJC to ensure all the discussion gets included when we collect it.