Results Summary

What was the research about?

Kidney disease affects more than 30 million adults in the United States. Advanced kidney disease can turn into kidney failure with little warning.

Treatments for kidney failure, such as dialysis or kidney transplant, can lengthen life. But each treatment has benefits and harms. If patients know about treatment options, they can choose a treatment that is right for them before kidney failure happens.

In this study, the research team tested whether a kidney transitions care program helped prepare patients for kidney failure. The program had two parts. First, clinics added alerts in patients’ health records to tell doctors when patients were ready for a transition in kidney care. Second, patients received support and education. A nurse and community health assistant offered classes on how to manage kidney disease, plans for kidney failure, and choosing a treatment. They also helped coordinate patients’ care. The team compared patients in the program with patients who received usual care.

What were the results?

Compared with patients who received usual care, patients in the program were more likely to have their kidney treatment preferences included in their health records.

Patients in the program and patients who received usual care didn’t differ in:

  • Reports of feeling able to make decisions about their care and to manage their care
  • Choice of kidney failure treatment
  • Number of hospital stays
  • Referrals for kidney failure treatment that matched patients’ choices
  • The number of patients who had to get unplanned dialysis
  • The time it took for patients to develop kidney failure
  • The number of patients who received surgical preparation for dialysis

Who was in the study?

The study included 1,473 patients with advanced kidney disease. Of these patients, 99 percent were White and 1 percent were non-White; less than 1 percent were Hispanic. The average age was 74, and 57 percent were women. All received care at one of eight clinics in rural Pennsylvania.

What did the research team do?

The research team assigned clinics by chance to the kidney transitions care program or usual care. Patients received the program assigned to the clinic. For usual care, clinics followed recommended guidelines for transitions in kidney care treatment.

The research team surveyed patients by phone about their preferences and care. The team also looked at information in patients’ health records.

Patients with kidney disease, their family members, representatives from health systems, and doctors helped create the program and provided input on the study.

What were the limits of the study?

Few patients took the education and self-management classes in the program. Results may have differed if more patients had taken the classes. The study took place in one health system; most patients were White. Results may differ in other places or for patients of other racial and ethnic backgrounds.

Future research could continue to look at ways to prepare patients with advanced kidney disease for kidney failure treatment.

How can people use the results?

Doctors and clinics can use the results when considering ways to improve support for patients with advanced kidney disease.

Final Research Report

This project's final research report is expected to be available by July 2023.

Peer-Review Summary

The Peer-Review Summary for this project will be posted here soon.

Conflict of Interest Disclosures

Project Information

Leigh E. Boulware, MD, MPH
Duke University
Putting Patients at the Center of Kidney Care Transitions

Key Dates

April 2015
January 2023

Study Registration Information


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Last updated: December 2, 2022