was announced on jama internal medicine. is here Link Go to article.
Regenstrief Institute Author: Dr. Rachel Patzer
abstract
Importance: People with advanced chronic kidney disease (CKD) have the best chance of living a longer, healthier life if they receive a kidney transplant. However, many barriers prevent patients from transplanting.
the purpose: To assess the effectiveness of a multicomponent intervention designed to target several barriers that prevent eligible patients from completing critical steps to receive a kidney transplant.
Design, setting, and participants: This pragmatic, two-arm, parallel-group, open-label, registration-based, superiority, cluster-randomized clinical trial was conducted in Ontario, Canada, from November 1, 2017 to December 31, 2021. All 26 CKD programs tested were included. These programs provide care for patients with advanced CKD (patients nearing the need for dialysis or patients receiving maintenance dialysis).
intervention: We used stratified, covariate-constrained randomization, assigned CKD programs in a 1:1 ratio, and compared multicomponent interventions to usual care over 4.2 years. This intervention had four main components. (1) Administrative support for establishing regional quality improvement teams. (2) Transplant educational resources. (3) Efforts for transplant recipients and living donors to share stories and experiences. (4) program-level performance reporting and oversight by management leaders;
Main results and measures: The primary outcome was the proportion of steps completed before receiving a kidney transplant. Each patient can complete up to four steps. Step 1, you will be referred to a transplant center for evaluation. Step 2, have the living donor candidate contact the transplant center for evaluation. Step 3, you will be added to the deceased donor waiting list. Step 4: Receive a transplant from a living or deceased donor.
result: During the study period, 26 CKD programs (13 intervention, 13 usual care) included 20,375 patients with advanced CKD who were potentially transplant eligible (intervention group) [n = 9780 patients]regular care group [n = 10 595 patients]). Despite evidence of intervention implementation, step completion rates were not significantly different between the intervention and usual care groups: 5334 vs. 5638 steps. 24.8 vs. 24.1 steps per 100 patient-years. Adjusted hazard ratio, 1.00 (95% CI, 0.87-1.15).
Conclusion and relevance: This new multicomponent intervention did not significantly increase the rate of completion of steps to receive a kidney transplant. Improving access to transplantation remains a global priority and requires significant efforts.
This research was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC).
author:
Amit x Garg 1 2 3 4 5 6Seychelles Johanna 1Kyla L. Naylor 2 3 4Susan Q. McKenzie 5 6István Muksi 7 8Stephanie N. Dixon 2 3 4Bing Luo twenty threeJessica M. Sontrop twenty fourMary Beaucage 9 10 11Dmitri Belenko 12Candice Coghlan 13Rebecca Cooper 14 15Lori Elliott 16Leah Getchell 2 17Estiheal 16Vincent Ki 16 18Gihad Nesrallah 12 19Rachel E. Patzer 20 21Justin Presso 22 23Marian Reich twenty fourDarin Treleaven 15 25Carol Wang 2 26 27Amy D. Waterman 28Jeffrey Salzman 15 29Peter G. Blake 2 16 26
Affiliation:
1Department of Nephrology, McMaster University School of Medicine, Hamilton, Ontario, Canada.
2Lawson Health Research Institute and London Health Sciences Centre, London, Ontario, Canada.
3ICES, Ontario, Canada.
FourDepartment of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
FiveKidney Patient and Donor Alliance, Canada.
6Transplant Ambassador Program in Ontario, Canada.
7Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada.
8Department of Nephrology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
9Patient Governance Circle, Indigenous Engagement Research Council and Executive Committee, Can-Solve CKD, Vancouver, British Columbia, Canada.
TenOntario Renal Network, Provincial Patient and Family Advisory Committee, Toronto, Ontario, Canada.
11Patient co-led Theme 1 – Improving the Culture of Donation of the Canadian Donation and Transplantation Research Program in Edmonton, Alberta, Canada.
12Department of Nephrology, University of Toronto, Toronto, Ontario, Canada.
13Center for Living Organ Donation, University Health Network, Toronto, Ontario, Canada.
14Ontario Renal Network, Toronto, Ontario, Canada.
15Trillium Gift of Life Network, Ontario Health, Toronto, Ontario, Canada.
16Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada.
17Can-SOLVE CKD Network, Vancouver BC, Canada.
18Trillium Health Partners, Mississauga, Ontario, Canada.
19Department of Medicine, Humber River Regional Hospital, Toronto, Ontario, Canada.
20Regentsleaf Institute, Indianapolis, Indiana.
twenty oneDepartment of Transplant Surgery, Indiana University School of Medicine, Indianapolis.
twenty twoClinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada.
twenty threeDepartment of Epidemiology and Public Health, University of Ottawa, Ontario, Canada.
twenty fourCanadians Seeking Solutions and Innovations to Beat Chronic Kidney Disease (CKD), Patient Council, Vancouver, British Columbia, Canada.
twenty fiveMcMaster University, Hamilton, Ontario, Canada.
26Department of Nephrology, School of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
27Department of Research Methods, Evidence and Uptake, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
28Houston Methodist Hospital, Department of Surgery and JC Walter Jr. Transplant Center, Houston, Texas.
29Department of Nephrology, St. Michael’s Hospital, Toronto, Ontario, Canada.
