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

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers stated that the causal model underlying the research question was not well-specified, so the hypothesized pathway between the intervention and outcomes was not clear. The researchers clarified that they based their framework on the Chronic Care Model and added text to the report explaining this model and how it was used for this study.
  • The reviewers asked the researchers to provide more detail on their methods, such as how they blinded providers and study participants to the interventions. The researchers explained that the clinics were randomized to an intervention so all providers and participants in a clinic experienced the same intervention. Therefore, providers and study participants were not blinded to condition, but the people assessing outcomes were.
  • The reviewers disagreed with the researchers’ conclusions about the generalizability of their results. The reviewers noted that the researchers implemented a novel intervention in a single health system. Therefore, the reviewers did not consider this study to be pragmatic. The researchers edited the report by further emphasizing the limited generalizability of the study and by removing any reference to this study being pragmatic.
  • The reviewers noted that the researchers did not conduct a pilot study to test the acceptability of the novel intervention, which might have informed the researchers about the potential for low uptake. The researchers acknowledged that they did not conduct a formal pilot study, but they did test the intervention in a different clinic shortly before the study began and found no problems with update. In the report, they commented that it would have been useful to complete a longitudinal pilot study in several clinics before implementing the full study.

Conflict of Interest Disclosures

Project Information

Leigh E. Boulware, MD, MPH
Duke University
$5,721,203
10.25302/07.2023.IHS.14092096
Putting Patients at the Center of Kidney Care Transitions

Key Dates

April 2015
January 2023
2015
2022

Study Registration Information

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Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
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Last updated: April 23, 2024