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Porteny T, Kennefick K, Lynch M, Velasquez AM, Damron KC, Rosas S, Allen J, Wiener DE, Kalloo S, Rizzolo K, Ladin K. The Need for Culturally Tailored CKD Education in Older Latino Patients and Their Families. Am J Kidney Dis 2024:S0272-6386(24)00905-3. [PMID: 39127400 DOI: 10.1053/j.ajkd.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 06/06/2024] [Accepted: 06/13/2024] [Indexed: 08/12/2024]
Abstract
Older Latino adults (65+) comprise the fastest growing minoritized group among the older population in the US and experience a disproportionate burden of kidney failure as well as disparities in kidney care compared to non-Hispanic White individuals. Despite significant need and barriers uniquely faced by this population, few educational resources or decision aids are available to meet the language and cultural needs of Latino patients. Decision aids are designed to improve knowledge and empower individuals to engage in shared decision-making and have been shown to improve decisional quality and goal-concordant care among older patients with CKD. In this commentary, we examine the barriers faced by older Latino people with CKD who must make dialysis initiation decisions. We conclude that there is a need for culturally concordant decision aids tailored for older Latino patients with CKD to overcome barriers in access to care and improve patient-centered care for older Latino CKD patients.
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Affiliation(s)
- Thalia Porteny
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY.
| | - Kristen Kennefick
- Research on Ethics, Aging, and Community Health (REACH Lab), Tufts University, Medford, MA
| | - Mary Lynch
- Research on Ethics, Aging, and Community Health (REACH Lab), Tufts University, Medford, MA
| | - Angie M Velasquez
- Research on Ethics, Aging, and Community Health (REACH Lab), Tufts University, Medford, MA
| | | | - Sylvia Rosas
- National Kidney Foundation, New York, NY; Joslin Diabetes Center and Harvard Medical School, Boston, MA
| | - Jennifer Allen
- Department of Community Health, Tufts University, Medford, MA
| | - Daniel E Wiener
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, MA
| | - Sean Kalloo
- Columbia University, Irving Medical Center, Division of Nephrology, New York, NY
| | - Katherine Rizzolo
- Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Section of Nephrology, Boston, MA
| | - Keren Ladin
- Research on Ethics, Aging, and Community Health (REACH Lab), Tufts University, Medford, MA; Department of Community Health, Tufts University, Medford, MA
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Koukounas KG, Kim D, Patzer RE, Wilk AS, Lee Y, Drewry KM, Mehrotra R, Rivera-Hernandez M, Meyers DJ, Shah AD, Thorsness R, Schmid CH, Trivedi AN. Pay-for-Performance Incentives for Home Dialysis Use and Kidney Transplant. JAMA HEALTH FORUM 2024; 5:e242055. [PMID: 38944762 PMCID: PMC11215557 DOI: 10.1001/jamahealthforum.2024.2055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/15/2024] [Indexed: 07/01/2024] Open
Abstract
Importance The Centers for Medicare & Medicaid Services' mandatory End-Stage Renal Disease Treatment Choices (ETC) model, launched on January 1, 2021, randomly assigned approximately 30% of US dialysis facilities and managing clinicians to financial incentives to increase the use of home dialysis and kidney transplant. Objective To assess the ETC's association with use of home dialysis and kidney transplant during the model's first 2 years and examine changes in these outcomes by race, ethnicity, and socioeconomic status. Design, Setting, and Participants This retrospective cross-sectional study used claims and enrollment data for traditional Medicare beneficiaries with kidney failure from 2017 to 2022 linked to same-period transplant data from the United Network for Organ Sharing. The study data span 4 years (2017-2020) before the implementation of the ETC model on January 1, 2021, and 2 years (2021-2022) following the model's implementation. Exposure Receiving dialysis treatment in a region randomly assigned to the ETC model. Main Outcomes and Measures Primary outcomes were use of home dialysis and kidney transplant. A difference-in-differences (DiD) approach was used to estimate changes in outcomes among patients treated in regions randomly selected for ETC participation compared with concurrent changes among patients treated in control regions. Results The study population included 724 406 persons with kidney failure (mean [IQR] age, 62.2 [53-72] years; 42.5% female). The proportion of patients receiving home dialysis increased from 12.1% to 14.3% in ETC regions and from 12.9% to 15.1% in control regions, yielding an adjusted DiD estimate of -0.2 percentage points (pp; 95% CI, -0.7 to 0.3 pp). Similar analysis for transplant yielded an adjusted DiD estimate of 0.02 pp (95% CI, -0.01 to 0.04 pp). When further stratified by sociodemographic measures, including age, sex, race and ethnicity, dual Medicare and Medicaid enrollment, and poverty quartile, there was not a statistically significant difference in home dialysis use across joint strata of characteristics and ETC participation. Conclusions and Relevance In this cross-sectional study, the first 2 years of the ETC model were not associated with increased use of home dialysis or kidney transplant, nor changes in racial, ethnic, and socioeconomic disparities in these outcomes.
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Affiliation(s)
- Kalli G. Koukounas
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Daeho Kim
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Rachel E. Patzer
- Regenstrief Institute, Indianapolis, Indiana
- Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis
| | - Adam S. Wilk
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Yoojin Lee
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Kelsey M. Drewry
- Regenstrief Institute, Indianapolis, Indiana
- Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis
| | - Rajnish Mehrotra
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington School of Medicine, Seattle
| | - Maricruz Rivera-Hernandez
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - David J. Meyers
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Ankur D. Shah
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Kidney Disease and Hypertension, Rhode Island Hospital, Providence
| | - Rebecca Thorsness
- Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Christopher H. Schmid
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | - Amal N. Trivedi
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
- Providence VA Medical Center, Providence, Rhode Island
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Rodriguez RA, Sparks MA, Conway PT, Gavhane A, Reddy S, Awdishu L, Waheed S, Davidson S, Adey DB, Lea JP, Lieske JC, McDonald FS. American Board of Internal Medicine Nephrology Procedure Requirements for Initial Certification: Time for a Change and Pursuing Consensus in the Nephrology Community. Am J Kidney Dis 2024:S0272-6386(24)00720-0. [PMID: 38640993 DOI: 10.1053/j.ajkd.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 04/21/2024]
Abstract
In 1988, the American Board of Internal Medicine (ABIM) defined essential procedural skills in nephrology, and candidates for ABIM certification were required to present evidence of possessing the skills necessary for placement of temporary dialysis vascular access, hemodialysis, peritoneal dialysis, and percutaneous renal biopsy. In 1996, continuous renal replacement therapy was added to the list of nephrology requirements. These procedure requirements have not been modified since 1996 while the practice of nephrology has changed dramatically. In March 2021, the ABIM Nephrology Board embarked on a policy journey to revise the procedure requirements for nephrology certification. With the guidance of nephrology diplomates, training program directors, professional and patient organizations, and other stakeholders, the ABIM Nephrology Board revised the procedure requirements to reflect current practice and national priorities. The approved changes include the Opportunity to Train standard for placement of temporary dialysis catheters, percutaneous kidney biopsies, and home hemodialysis, which better reflects the current state of training in most training programs, and the new requirements for home dialysis therapies training will align with the national priority to address the underuse of home dialysis therapies. This perspective details the ABIM process for considering changes to the certification procedure requirements and how ABIM collaborated with the larger nephrology community in considering revisions and additions to these requirements.
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Affiliation(s)
- Rudolph A Rodriguez
- Department of Medicine, University of Washington, Seattle, Washington; Hospital and Specialty Medicine, VA Puget Sound Health Care System, Seattle, Washington.
| | - Matthew A Sparks
- Division of Nephrology, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina; Renal Section, Durham VA Health Care System, Durham, North Carolina
| | - Paul T Conway
- American Association of Kidney Patients, Tampa, Florida
| | - Anamika Gavhane
- American Board of Internal Medicine, Philadelphia, Pennsylvania
| | - Siddharta Reddy
- American Board of Internal Medicine, Philadelphia, Pennsylvania
| | - Linda Awdishu
- Division of Clinical Pharmacy, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, California
| | - Sana Waheed
- Department of Medicine, Renal Division, School of Medicine, Emory University, Atlanta, Georgia
| | - Sandra Davidson
- American Board of Internal Medicine, Philadelphia, Pennsylvania
| | - Deborah B Adey
- Department of Medicine, Kidney Transplant Service, Division of Nephrology, University of California, San Francisco, California
| | - Janice P Lea
- Department of Medicine, Renal Division, School of Medicine, Emory University, Atlanta, Georgia
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Furman S McDonald
- American Board of Internal Medicine, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
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Rizzolo K, Gonzalez Jauregui R, Barrientos I, Teakell J, Camacho C, Chonchol M, Waikar SS, Cervantes L. Barriers and Facilitators to Home Dialysis Among Latinx Patients with Kidney Disease. JAMA Netw Open 2023; 6:e2328944. [PMID: 37581885 PMCID: PMC10427944 DOI: 10.1001/jamanetworkopen.2023.28944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/02/2023] [Indexed: 08/16/2023] Open
Abstract
Importance Latinx people have a high burden of kidney disease but are less likely to receive home dialysis compared to non-Latinx White people. The disparity in home dialysis therapy has not been completely explained by demographic, medical, or social factors. Objective To understand the barriers and facilitators to home dialysis therapy experienced by Latinx individuals with kidney failure receiving home dialysis. Design, Setting, and Participants This qualitative study used semistructured interviews with Latinx adults with kidney failure receiving home dialysis therapy in Denver, Colorado, and Houston, Texas, between November 2021 and March 2023. Patients were recruited from home dialysis clinics affiliated with academic medical centers. Of 39 individuals approached, 27 were included in the study. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Main Outcomes and Measures Themes and subthemes regarding barriers and facilitators to home dialysis therapy. Results A total of 27 Latinx adults (17 [63%] female and 10 [37%] male) with kidney failure who were receiving home dialysis participated. Themes and subthemes were identified, 3 related to challenges with home dialysis and 2 related to facilitators. Challenges to home dialysis included misinformation and immigration-related barriers to care (including cultural stigma of dialysis, misinformation regarding chronic disease care, and lack of health insurance due to immigration status), limited dialysis education (including lack of predialysis care, no-nephrologist education, and shared decision-making), and maintenance of home dialysis (including equipment issues, lifestyle restrictions, and anxiety about complications). Facilitators to home dialysis included improved lifestyle (including convenience, autonomy, physical symptoms, and dietary flexibility) and support (including family involvement, relationships with staff, self-efficacy, and language concordance). Conclusions and Relevance Latinx participants in this study who were receiving home dialysis received misinformation and limited education regarding home dialysis, yet were engaged in self-advocacy and reported strong family and clinic support. These findings may inform new strategies aimed at improving access to home dialysis education and uptake for Latinx individuals with kidney disease.
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Affiliation(s)
- Katherine Rizzolo
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | | | - Ileana Barrientos
- Division of Renal Diseases and Hypertension, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Jade Teakell
- Division of Renal Diseases and Hypertension, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Claudia Camacho
- Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora
| | - Michel Chonchol
- Division of Nephrology, University of Colorado-Anschutz Medical Campus, Aurora
| | - Sushrut S. Waikar
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Lilia Cervantes
- Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora
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Miller F, Murray J, Budhota A, Harake T, Steig A, Whittaker D, Gupta S, Sivaprakasam R, Kuraguntla D. Evaluation of a wearable biosensor to monitor potassium imbalance in patients receiving hemodialysis. SENSING AND BIO-SENSING RESEARCH 2023. [DOI: 10.1016/j.sbsr.2023.100561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
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Sarnak MJ, Auguste BL, Brown E, Chang AR, Chertow GM, Hannan M, Herzog CA, Nadeau-Fredette AC, Tang WHW, Wang AYM, Weiner DE, Chan CT. Cardiovascular Effects of Home Dialysis Therapies: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e146-e164. [PMID: 35968722 DOI: 10.1161/cir.0000000000001088] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage kidney disease. Currently, thrice-weekly in-center hemodialysis for 3 to 5 hours per session is the most common therapy worldwide for patients with treated kidney failure. Outcomes with thrice-weekly in-center hemodialysis are poor. Emerging evidence supports the overarching hypothesis that a more physiological approach to administering dialysis therapy, including in the home through home hemodialysis or peritoneal dialysis, may lead to improvement in several cardiovascular risk factors and cardiovascular outcomes compared with thrice-weekly in-center hemodialysis. The Advancing American Kidney Health Initiative, which has a goal of increasing the use of home dialysis, is aligned with the American Heart Association's 2024 mission to champion a full and healthy life and health equity. We conclude that incorporation of interdisciplinary care models to increase the use of home dialysis therapies in an equitable manner will contribute to the ultimate goal of improving outcomes for patients with kidney failure and cardiovascular disease.
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Godwin M. Advocating for Health Equity in Kidney Care: An Urgent Need. Kidney Med 2021; 3:1082-1085. [PMID: 34493998 PMCID: PMC8413107 DOI: 10.1016/j.xkme.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Fissell RB, Cavanaugh KL. Barriers to home dialysis: Unraveling the tapestry of policy. Semin Dial 2020; 33:499-504. [PMID: 33210358 DOI: 10.1111/sdi.12939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 12/22/2022]
Abstract
Home dialysis use as a treatment for end-stage kidney disease varies locally, nationally, and internationally. There is a call to action in the United States to significantly increase access and uptake of home dialysis as the preferred dialysis treatment option. Although most do not object to patient choice in modality selection, the reality is that there are multilevel barriers both obvious and subtle that interfere with expanding home dialysis access. Financial barriers and how payment is structured continue to be key drivers, although new models of care are emerging that include for the first time incentives rather than penalties regarding home dialysis. Resources to support implementation include expert personnel requiring educational training. Policies requiring training curriculum content that is not only specified within nephrology but also for these multidisciplinary providers requisite for successful home dialysis to ensure professional expertise is ready and available, and also to cultivate champions of home modality within the broader nephrology community. Perhaps most importantly, innovation through expanded investment in research is necessary to advance practices, elevate quality, and improve outcomes. Policy in a variety of sectors at local, regional, national, and international levels has the potential to drastically drive expansion and increasing success of home dialysis.
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Affiliation(s)
- Rachel B Fissell
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kerri L Cavanaugh
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA
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