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Waterman AD, McSorley AMM, Peipert JD, Goalby CJ, Peace LJ, Lutz PA, Thein JL. Explore Transplant at Home: a randomized control trial of an educational intervention to increase transplant knowledge for Black and White socioeconomically disadvantaged dialysis patients. BMC Nephrol 2015; 16:150. [PMID: 26316264 PMCID: PMC4552175 DOI: 10.1186/s12882-015-0143-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/07/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Compared to others, dialysis patients who are socioeconomically disadvantaged or Black are less likely to receive education about deceased donor kidney transplant (DDKT) and living donor kidney transplant (LDKT) before they reach transplant centers, often due to limited availability of transplant education within dialysis centers. Since these patients are often less knowledgeable or ready to pursue transplant, educational content must be simplified, made culturally sensitive, and presented gradually across multiple sessions to increase learning and honor where they are in their decision-making about transplant. The Explore Transplant at Home (ETH) program was developed to help patients learn more about DDKT and LDKT at home, with and without telephone conversations with an educator. METHODS AND STUDY DESIGN In this randomized controlled trial (RCT), 540 low-income Black and White dialysis patients with household incomes at or below 250 % of the federal poverty line, some of whom receive financial assistance from the Missouri Kidney Program, will be randomly assigned to one of three education conditions: (1) standard-of-care transplant education provided by the dialysis center, (2) patient-guided ETH (ETH-PG), and (3) health educator-guided ETH (ETH-EG). Patients in the standard-of-care condition will only receive education provided in their dialysis centers. Those in the two ETH conditions will receive four video and print modules delivered over an 8 month period by mail, with the option of receiving supplementary text messages weekly. In addition, patients in the ETH-EG condition will participate in multiple telephonic educational sessions with a health educator. Changes in transplant knowledge, decisional balance, self-efficacy, and informed decision making will be captured with surveys administered before and after the ETH education. DISCUSSION At the conclusion of this RCT, we will have determined whether an education program administered to socioeconomically disadvantaged dialysis patients, over several months directly in their homes, can help more individuals learn about the options of DDKT and LDKT. We also will be able to examine the efficacy of different educational delivery approaches to further understand whether the addition of a telephone educator is necessary for increasing transplant knowledge. TRIAL REGISTRATION ClinicalTrials.gov, NCT02268682.
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Affiliation(s)
- Amy D Waterman
- Division of Nephrology, David Geffen School of Medicine at University of California, Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA, 90024, USA.
- Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
| | - Anna-Michelle M McSorley
- Division of Nephrology, David Geffen School of Medicine at University of California, Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA, 90024, USA.
| | - John D Peipert
- Division of Nephrology, David Geffen School of Medicine at University of California, Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA, 90024, USA.
- Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
| | - Christina J Goalby
- Division of Nephrology, David Geffen School of Medicine at University of California, Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA, 90024, USA.
- Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
| | - Leanne J Peace
- Missouri Kidney Program, University of Missouri, Columbia, AP Green Building, Suite 111, 201 Business Loop-70 W, Columbia, MO, 65211, USA.
| | - Patricia A Lutz
- Missouri Kidney Program, University of Missouri, Columbia, AP Green Building, Suite 111, 201 Business Loop-70 W, Columbia, MO, 65211, USA.
| | - Jessica L Thein
- Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
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Abstract
Sudden cardiac death (SCD) accounts for a quarter of all deaths in end-stage renal disease (ESRD) patients. While causative mechanisms of SCD in this high risk population remain poorly defined, interaction of the vulnerable myocardium with dialysis-related arrhythmic triggers is thought to play a major role. Recent evidence suggests that dialysis-induced derangement of calcium concentrations contributes to the increased risk of all-cause and cardiovascular mortality, vascular calcification, and SCD. Current KDIGO guidelines recommend avoiding high dialysate calcium concentrations as a precaution against adverse outcomes of increased calcium burden and vascular calcification. Conversely, low calcium concentration is also implicated in the development of SCD via increased QT dispersion and prolonged QT interval. Consequently, the optimal dialysate calcium concentration in dialysis patients remains debated and further studies are needed to establish the best strategy for managing calcium in dialysis patients.
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Affiliation(s)
- Esther D Kim
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Rulan S Parekh
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children and the University Health Network, Toronto, Ontario, Canada.,Department of Pediatrics and Medicine, School of Medicine, University of Toronto, Toronto, Ontario, Canada
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