Disparities in Discussions about Kidney Replacement Therapy in CKD Care

Barrett, Tyler M.; Davenport, Clemontina A.; Ephraim, Patti L.; Peskoe, Sarah B.; Mohottige, Dinushika; DePasquale, Nicole; McElroy, Lisa M.; Boulware, L. Ebony

doi:10.34067/kid.0004752021

Cited by 12 publications

(22 citation statements)

References 12 publications

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“… 35 The Checklist may further help address the documented differential access of groups to SDM by introducing a way for practitioners to evaluate their provision of SDM to patients systematically. 17 Indeed, it is our aim that appropriate implementation of the Checklist across groups by providers will increase SDM access for those often at a disadvantage when it comes to SDM, including minorities, women, and lower-income patients. 17 , 35 We echo Benito and Luis in cautioning that the details of SDM and implementation of the Checklist will vary based on individual case needs.…”

Section: Discussionmentioning

confidence: 99%

“… 17 Indeed, it is our aim that appropriate implementation of the Checklist across groups by providers will increase SDM access for those often at a disadvantage when it comes to SDM, including minorities, women, and lower-income patients. 17 , 35 We echo Benito and Luis in cautioning that the details of SDM and implementation of the Checklist will vary based on individual case needs. 34 However, establishing optimal ESKD treatment lead time through early SDM supports improvement in the quality of pre-ESKD nephrology care and may even improve patient engagement and empowerment.…”

Section: Discussionmentioning

confidence: 99%

“… 34 While this is important, providers also need to critically examine variations in SDM for societal bias and to reduce disparities. For example, Barrett et al 17 assessed responses from participants enrolled in a randomized trial aimed at evaluating patient–nephrologist interactions about kidney replacement therapies. They considered whether patients had spoken with their doctor about how various options could affect their quality of life, life expectancy, finances, family, and need for assistance.…”

Section: The Current State Of Sdm In Eskdmentioning

confidence: 99%

“… 13–16 Therefore, investigators and professional renal organizations have repeatedly recommended using SDM to increase patient-centered utilization of home dialysis therapies for all patients with advanced, stage 4 and 5 CKD. 17 , 18 …”

Section: Introductionmentioning

confidence: 99%

“…Thus, disparities in SDM contribute to disparities in ESKD care in terms of lower rates of functioning vascular access, 19 , 20 kidney transplantations, and home dialysis therapies. 17 , 25 …”

Section: Introductionmentioning

confidence: 99%

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Supporting Shared Decision-Making and Home Dialysis in End-Stage Kidney Disease

Campbell‐Montalvo¹,

Jia²,

Shukla³

2022

IJNRD

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It has been widely demonstrated that patient education and empowerment, especially involving shared treatment decisions, improve patient outcomes in chronic medical conditions, including chronic kidney disease requiring kidney replacement therapies. Accordingly, regulatory agencies in the US and worldwide recommend shared decision-making for finalizing one’s choice of kidney replacement therapy. It is also recognized that the US needs to substantially increase home dialysis utilization to leverage its positive impacts on patient and healthcare cost-related outcomes. This perspective highlights how the routine clinical use of the recommended practice of shared decision-making can exist in synergy with the system’s goal for increased home dialysis use. It introduces a pragmatic provider checklist, The Nephrologist’s Shared Decision-Making Checklist, grounded in the relevant theories of shared decision-making, and, unlike some research assessments and extant tools, is easy to understand and implement in clinical practice. This qualitative Checklist can help providers ensure that they have co-constructed an SDM experience with the patient and involved caretakers, helping them benefit from the improved outcomes associated with SDM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: The Current State Of Sdm In Eskdmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Supporting Shared Decision-Making and Home Dialysis in End-Stage Kidney Disease

Campbell‐Montalvo¹,

Jia²,

Shukla³

2022

IJNRD

View full text Add to dashboard Cite

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Disparities in Kidney Transplant Waitlisting Among Young Patients Without Medical Comorbidities

Husain,

Yu,

King

et al. 2023

JAMA Intern Med

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ImportanceDisparities in kidney transplant referral and waitlisting contribute to disparities in kidney disease outcomes. Whether these differences are rooted in population differences in comorbidity burden is unclear.ObjectiveTo examine whether disparities in kidney transplant waitlisting were present among a young, relatively healthy cohort of patients unlikely to have medical contraindications to kidney transplant.Design, Setting, and ParticipantsThis retrospective cohort study used the US Renal Data System Registry to identify patients with end-stage kidney disease who initiated dialysis between January 1, 2005, and December 31, 2019. Patients who were older than 40 years, received a preemptive transplant, were preemptively waitlisted, or had documented medical comorbidities other than hypertension or smoking were excluded, yielding an analytic cohort of 52 902 patients. Data were analyzed between March 1, 2022, and February 1, 2023.Main Outcome(s) and Measure(s)Kidney transplant waitlisting after dialysis initiation.ResultsOf 52 902 patients (mean [SD] age, 31 [5] years; 31 132 [59%] male; 3547 [7%] Asian/Pacific Islander, 20 782 [39%] Black/African American, and 28 006 [53%] White) included in the analysis, 15 840 (30%) were waitlisted for a kidney transplant within 1 year of dialysis initiation, 11 122 (21%) were waitlisted between 1 and 5 years after dialysis initiation, and 25 940 (49%) were not waitlisted by 5 years. Patients waitlisted within 1 year of dialysis initiation were more likely to be male, to be White, to be employed full time, and to have had predialysis nephrology care. There were large state-level differences in the proportion of patients waitlisted within 1 year (median, 33%; range, 15%-58%). In competing risk regression, female sex (adjusted subhazard ratio [SHR], 0.92; 95% CI, 0.90-0.94), Hispanic ethnicity (SHR, 0.77; 95% CI, 0.75-0.80), and Black race (SHR, 0.66; 95% CI, 0.64-0.68) were all associated with lower waitlisting after dialysis initiation. Unemployment (SHR, 0.47; 95% CI, 0.45-0.48) and part-time employment (SHR, 0.74; 95% CI, 0.70-0.77) were associated with lower waitlisting compared with full-time employment, and more than 1 year of predialysis nephrology care, compared with none, was associated with greater waitlisting (SHR, 1.51; 95% CI, 1.46-1.56).Conclusions and RelevanceThis retrospective cohort study found that fewer than one-third of patients without major medical comorbidities were waitlisted for a kidney transplant within 1 year of dialysis initiation, with sociodemographic disparities in waitlisting even in this cohort of young, relatively healthy patients unlikely to have a medical contraindication to transplantation. Transplant policy changes are needed to increase transparency and address structural barriers to waitlist access.

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