Project Summary

What is the research about?

Kidney transplantation is an optimal treatment for patients with kidney failure. Kidney failure affects over 600,000 adults in the United States. Black individuals have up to four-fold greater rates of kidney failure when compared to others. When kidneys fail, patients need treatments (such as dialysis or a kidney transplant) to prolong their lives. Studies show patients’ outcomes are better when they receive transplants as early as possible. Currently, however, fewer than 3 percent of patients with kidney failure start treatment with a kidney transplant, and individuals from Black and rural communities are least likely to receive early transplants.

Patients experience a number of critical roadblocks on the path to receiving early kidney transplants. These roadblocks include patients’ poor knowledge, patients’ difficulties discussing transplant with their physicians and families, physicians’ late referrals for evaluations, and patients’ difficulties completing the transplant evaluation process. Roadblocks are worse for Black and rural individuals. Patients and families have said they feel overwhelmed at the prospect of needing a kidney transplant, and they need help to overcome these roadblocks.

This study will provide information to help understand how health systems can overcome roadblocks to improve patients’ receipt of early kidney transplants overall and among Black and rural individuals.

Who can this research help?

Hospital and health insurance leaders can use findings from this study to change ways they work to help people get kidney transplants early and equitably.

What is the research team doing?

The research team will study how health systems can help more patients overcome roadblocks to achieve early kidney transplants. Patients receiving care in three health systems will test a new intervention, called 'STEPS.'

STEPS will (1) identify patients qualifying for kidney transplants as early as possible, (2) support patients and their families with education and behavioral support to help them talk about overcoming roadblocks to early transplants, (3) proactively reach out to patients to let them know they are eligible for early transplants and invite them to the transplant center, and (4) navigate patients through the multi-step transplant preparation process.

The researchers will randomly assign patients to receive STEPS or to receive their usual kidney care, which the researchers will augment by alerting patients’ physicians to current clinical practice guidelines. Over 18 months, the team will compare differences in how these two treatment approaches help patients overcome critical roadblocks toward receiving early kidney transplants, including talking with their families and physicians, initiating and completing their transplant evaluations, and identifying living kidney donors.

How are stakeholders engaged?

Patients, family members, and other kidney disease stakeholders (policy makers, insurers, health care providers) have helped design this study. They are also part of the research team and will be involved in the study throughout its duration.

What will be the study impact?

If effective, STEPS will provide a valuable model for how health systems across the nation can improve patients’ lives by helping them get kidney transplants early and equitably.

Project Information

Leigh Ebony Boulware, MD, MPH, FACP
Duke University

Key Dates

January 2021
December 2026


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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: September 26, 2023