Breaking Down Care Process and Patient-level Barriers to Arteriovenous Access Creation Prior to Hemodialysis Initiation

University of North Carolina (UNC)

Status: Completed

Conditions: Chronic Kidney Disease; Chronic Kidney Disease Requiring Chronic Dialysis

Treatments: Other: Vascular Access Navigation and Education Quality Improvement Program

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT04032613

1R21DK116115 (U.S. NIH Grant/Contract)

18-1912

Details and patient eligibility

About

More than 80% of individuals in the U.S. start maintenance hemodialysis (HD) with a central venous catheter, despite substantial evidence that starting HD with an arteriovenous (AV) access improves quality of life, lowers mortality, and decreases healthcare costs. Health system- and patient-level barriers contribute to low rates of AV access creation prior to HD initiation. Evidence-based, pre-dialysis interventions to improve these low rates and associated clinical outcomes are lacking.

A Vascular Access Navigation and Education Quality Improvement Program will be implemented in the Geisinger Danville, PA chronic kidney disease clinic. Individuals who choose to participate in a research sub-study of the program will complete questionnaires to assess their vascular access care knowledge and confidence before and after participation in the quality improvement program.

Enrollment: 46 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria

Patients:

• Receive care at the Geisinger Danville Nephrology Clinic
• Age ≥ 18 years
• eGFR ≤ 25 mL/min/1.73 m and 2-year kidney failure risk score >10% based on kidney failure risk equation, or nephrologist recommendation for vascular access
• Participation in the Vascular Access Navigation and Education Quality Improvement Program

Providers: Professional involved in dialysis vascular access care (e.g., nephrologist, surgeon, kidney disease clinic nurse, etc.) at Geisinger in Danville, PA

Exclusion Criteria

Patients:

• Too far into the vascular access creation process to benefit from the intervention (e.g. completed vascular access surgery appointment or has a surgery appointment scheduled within the next 4 weeks),
• Inability to consent, or
• Inability to complete interviews in English

Providers: None

Trial design

Primary purpose: Health Services Research

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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46 participants in 1 patient group

Vascular access quality improvement program participants

Experimental group

Description:

All participants enrolled in the study who are involved in the Vascular Access Navigation and Education Quality Improvement Program.

Treatment:

Other: Vascular Access Navigation and Education Quality Improvement Program