Project Summary

What is the research about?

Kidney transplantation is an optimal treatment for patients with kidney failure. The 2019 Advancing American Kidney Health Initiative Presidential Order mandates that 80 percent of patients should receive a kidney transplant or home hemodialysis by 2025. Kidney failure affects over 600,000 adults in the United States. 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. Patients experience 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. Patients and families have said they feel overwhelmed at the prospect of needing a kidney transplant, and they need help to overcome these roadblocks.

Who can this research help?

Hospital and health insurance leaders can use findings from this study to learn about ways to help people get early kidney transplants.

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. They will enroll 800 people receiving care in two health systems to study a new intervention called Patient Centered Early Health System Transplant Outreach. This intervention 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 overcome 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 Patient Centered Early Health System Early Transplant Outreach or to receive their usual kidney care, which the researchers will augment by alerting patients’ physicians to current clinical practice guidelines recommending that patients should be under nephrology care and should begin discussions about transplantation. 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, healthcare 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, Patient Centered Health System Early Transplant Outreach will provide an important model for how health systems can help to improve kidney transplants and the lives of patients and families with kidney disease across the US.

Project Information

Leigh Ebony Boulware, MD, MPH, FACP
Duke University

Key Dates

January 2021
December 2026


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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: November 30, 2022