Using Peer Mentors to screen for CKD at dialysis units: Targeting high‐risk family members

Abstract

OBJECTIVE: The incidence of chronic kidney disease (CKD) is increasing and affects one in nine individuals in the United States. Genetics and lifestyle factors contribute to the incidence of CKD and serve as screening targets. We screened for predisposition to CKD at dialysis units in southeast Michigan, where obesity and hypertension are common. Families of dialysis patients, as well as non-relatives and staff, were evaluated. Peer Mentors with CKD participated in the screening.METHODS: "Prevention Fairs" utilized inexpensive screening to determine a predisposition to CKD: urine dipstick for protein, glucose, or blood; BP > 140/90; and body mass index (BMI) > 30. Peer Mentor participation, honoring long-standing patients, and invitations to state legislators were included.RESULTS: "Fairs" at 16 Michigan centers screened 497 individuals: 61% (305) had one fi nding, 18% (88) had two, and 6% (29) had three. Obesity was most common (220), and then hypertension (169), proteinuria (41), glycosuria (15), and hematuria (13). Although we had hypothesized that the highest risk would be found among genetic family members, positive screening was not statistically different between genetic relatives and other individuals. In addition, fi ndings were distributed equally across varied demographic settings and races, underscoring the importance of social determinants of health.DISCUSSION Genetic factors are hypothesized to be predictors for CKD, but these results suggest that CKD risk may also be related to social determinants such as diet, exercise, health consciousness, socioeconomics, or cultural acceptance of obesity. Screening at dialysis centers, enhanced by participation of peers and social activities, contributes to referral for further treatment.

Patient‐to‐patient peer mentor support in dialysis: Improving the patient experience

“…Mentor programs can be coordinated by a local dialysis or outpatient center or can be run from a renal network or region . The National Kidney Foundation (NKF) has developed this to a national basis through their NKF Peers program . Over the first 4 years, the peer support program has shown evidence of a beneficial impact on healthy behaviors.…”

“…The training consists of knowledge sharing, communication skills training, role‐playing, experiential responses, and nonjudgmental training . Knowledge relating to confidentiality, sharing experiences without sharing medical information, when to refer to health professionals and self‐management is commonly presented . Other processes that are undertaken may be confidentiality agreements and background checks .…”

“…The few studies focused on patient peer support in the ESKD population have shown a particular advantage for certain ethnic groups who have strong oral traditions. Patient peer support promoted greater credibility and trust in these groups, particularly if face‐to‐face meetings were included . The person‐to‐person approach of a peer can make sensitive subjects, such as quality of life and advance directives more acceptable to discuss, rather than written or didactic instructions …”

“…The mentor relationship can enhance decision‐making for both mentee and mentor through a more sensitive understanding of the kidney disease journey . Decisions related to treatment options, home dialysis, advance directives and encouraging family kidney disease screening have all been enhanced by patient peer support . Specific practical skills have been transferred, such as self‐cannulation skills .…”

“…3,14 The National Kidney Foundation (NKF) has developed this to a national basis through their NKF Peers program. 15 Over the first 4 years, the peer support program has shown evidence of a beneficial impact on healthy behaviors. Network groups can use online forums with varying success, particularly in younger adults who prefer to use more popular social media platforms.…”