NKF Survey and Kidney PATH Program: Education is Key to Addressing Home Dialysis and Transplant Awareness Disparities Among Patients
In a recent survey of ESKD dialysis patients in partnership with NKF, education was found to help close disparity gaps in awareness of home dialysis or transplant as treatment options among various racial and ethnic groups. NKF Michigan’s successful Kidney PATH program is piloting an educational curriculum to help reduce these perceived barriers.
It is well established that access to education about available dialysis options is crucial to minority and socioeconomically disadvantaged communities with end-stage kidney disease (ESKD)—populations that are disproportionately burdened by health risk factors for chronic kidney disease, and kidney failure. For instance, black ESKD patients are less likely to receive any pre-ESKD nephrology care (63.2%) than white patients (69.6%), which is associated with a higher risk of initiating dialysis in the hospital, and lower likelihood of selecting home dialysis as a treatment modality, according to the United States Renal Data System. To gain a better understanding of the reasons for these disparities and explore workable solutions, the National Kidney Foundation (NKF) and Outset Medical partnered with Hanover Research to conduct an online survey of 450 black, white, and other ethnicity ESKD patients—NKF members or from affiliated sites—who had initiated dialysis within the past 10 years.
In key survey findings, there appeared to be no racial disparities in adoption of home dialysis among patients who were connected to kidney disease educational organizations. However, socioeconomic factors did contribute to differences in early knowledge of kidney disease status and opportunities for early education prior to kidney failure.
The overall theme of the NKF/Outset survey results is that almost all patients noted they are aware of both in-center and at-home dialysis options, as well as kidney transplant, which may be a result of surveying a relatively small, educated audience. The survey included patients 18 or older, with 38% of respondents being black, 52% white, and 10% another ethnicity, with transplant recipients excluded.
“What we can learn from the results from this small sample of educated ESKD patients is there were no underlying race or ethnicity factors that would cause somebody to choose in-center over home dialysis. Rather, it’s more a construct of lack of education, as well as some socioeconomic factors that are barriers,” says Tonya Saffer, Outset Medical’s Head of Government Affairs and Market Access, who worked with NKF on the survey design.
Respondents older than 50 and with incomes of $75k or greater were found to be more likely to ease into dialysis, indicating that they were more aware of their kidney disease, while those younger than 50 and with incomes less than $75k were more likely to experience an unplanned or emergency start to treatment. More patients overall, however, are currently receiving in-center hemodialysis (67%) than at-home dialysis (42%), though respondents with higher annual household incomes are more likely to currently receive at-home dialysis than those with lower incomes. (See Box for additional survey findings regarding at-home dialysis.) Thus, socioeconomic factors, as supported by published literature, also appear to play a role in the disparities in awareness and utilization of treatment options such as home dialysis or kidney transplant.
RACIAL DISPARITIES IN DIALYSIS PATH TO TREATMENT SURVEY: PATIENT USE AND PERCEPTIONS OF HOME DIALYSIS
- Among those aware of home dialysis: patients are about equally likely to currently receive either home hemodialysis (HHD; 20%) or peritoneal dialysis (PD; 25%), although participants have more previous experience with PD (18%) than HHD (7%)
- There are no notable racial group differences on care team encouragement towards trying either HHD or PD
- Among those aware of but not currently receiving home dialysis, 41% have discussed the option with their care team in the last 6 