Quality initiative to inform dialysis modality selection for veterans with advanced kidney disease

Chronic kidney disease (CKD) is the ninth leading cause of death in the United States. Approximately two million people worldwide suffer from kidney failure requiring dialysis, and the number of patients diagnosed with the disease continues to increase at a rate of 5-7% per year. Despite the significant benefits of home-based dialysis (HBD) over in-center dialysis, HBD continues to be an underused modality worldwide. Underutilization is largely the result of an existing knowledge gap regarding dialysis options in advanced kidney disease patients. The purpose of this quality improvement project was to determine if a structured educational program implemented in a nephrology clinic serving veterans increased patients’ awareness and knowledge of the different dialysis modalities, increased informed selection of the HBD modality and improved provider adherence to providing the education. A before-after design structured clinical education was used to deliver a three-session educational program using interactive PowerPoint presentations, videos, and online educational tools. Thirteen patients received the educational program either in person or via phone call or telehealth visit over the three-month project period. Post-intervention, participants’ Kidney Knowledge Survey (KiKS) score significantly increased (t (12) = -12.84, p = <.001, d= 3.08); participants selecting HBD as their modality choice increased 46%; and providers’ adherence to education delivery reached 81%. Planned and timely discussions educating advanced kidney disease patients and their families about all dialysis modalities, including HBD, should be consistently provided to maximize informed decisions and quality of life.