Direct Delivery of Kidney Transplant Education to Black and Low-Income Patients Receiving Dialysis: A Randomized Controlled Trial

We examined the efficacy of 2 supplementary KT education approaches delivered directly to patients.Study DesignProspective, 3-arm parallel-group, randomized, controlled trial.Settings &ParticipantsAdult, black, and white low-income patients receiving dialysis in Missouri.InterventionPatients were randomly assigned to 1 of 3 educational conditions: (1) standard of care, usual KT education provided in dialysis centers (control); (2) Explore Transplant @ Home patient-guided, 4 modules of KT education sent directly to patients using print, video, and text messages; and (3) Explore Transplant @ Home educator-guided, the patient-guided intervention plus 4 telephonic discussions with an educator.OutcomesPrimary: patient knowledge of living (LDKT) and deceased donor KT (DDKT). Secondary: informed decision making, change in attitudes in favor of LDKT and DDKT, and change in the number of new steps taken toward KT.ResultsIn intent-to-treat analyses, patients randomly assigned to educator- and patient-guided interventions had greater knowledge gains (1.4 point increase) than control patients (0.8 point increase; P = 0.02 and P = 0.01, respectively). Compared with control patients, more patients randomly assigned to educator- and patient-guided interventions were able to make informed decisions about starting KT evaluation (82% vs 91% and 95%; P = 0.003), pursuing DDKT (70% vs 84% and 84%; P = 0.003), and pursuing LDKT (73% vs 91% and 92%;...
Source: American Journal of Kidney Diseases - Category: Urology & Nephrology Source Type: research

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CONCLUSIONS: Tx-ESRD patients have worse quality metrics related to anemia, phosphorus, albumin, and vascular access compared to Nat-ESRD patients. Nephrology care for patients with Tx-ESRD should be improved to address these quality metrics gaps. PMID: 31311008 [PubMed - as supplied by publisher]
Source: American Journal of Nephrology - Category: Urology & Nephrology Authors: Tags: Am J Nephrol Source Type: research
Sonia Mehrotra, Raj Kumar Sharma, Manas R PatelIndian Journal of Nephrology 2019 29(4):242-247 Vitamin-D has immuno-modulatory properties besides its role in mineral and bone disorder (MBD) and could have a role in allograft outcome. Fifty-two chronic kidney disease patients on dialysis going for transplantation were prospectively studied before and after renal transplantation. FGF23, 25(OH) vitamin D, 1,25-Dihydroxyvitamin D, PTH, serum Ca, serum PO4, and e-GFR status were evaluated. Vitamin D deficiency was seen in 25.0% of recipients before transplant (26.09 ± 12.19 ng/mL) and in 48.1% at 6 months post-tra...
Source: Indian Journal of Nephrology - Category: Urology & Nephrology Authors: Source Type: research
ConclusionThis study suggests that kidney transplantation is a better option over hemodialysis and peritoneal dialysis. We conclude that serious efforts ought to be made to foster potential brain-dead donors and altruistic kidney donation and promote peritoneal dialysis as a superior alternative to hemodialysis for eligible patients.
Source: Clinical Epidemiology and Global Health - Category: Epidemiology Source Type: research
This study developed a prediction tool for transition from PD to HD.Study DesignRetrospective cohort study.Setting &ParticipantsAdults initiating PD between January 2008 and December 2011, followed up through June 2015, for whom data were available in the US Renal Data System (USRDS).PredictorsClinical characteristics at PD initiation and peritonitis claims.OutcomesTransfer to HD, with the competing outcomes of death and kidney transplantation.Analytical ApproachOutcomes were ascertained from USRDS treatment history files. Subdistribution hazards (competing-risk) models were fit using clinical characteristics at PD ini...
Source: American Journal of Kidney Diseases - Category: Urology & Nephrology Source Type: research
ConclusionClinicians prescribing ICIs should be aware that SOT recipients are at risk of transplant rejection as a result of T cell activation. Dd-cfDNA is a sensitive biomarker and should be further studied for early detection of transplant rejection. Immunological analysis of the kidney explant showed marked graft infiltration with alloreactive PD-1+ cytotoxic T cells that were saturated with nivolumab.
Source: Journal for Immunotherapy of Cancer - Category: Cancer & Oncology Source Type: research
President Donald Trump on Wednesday signed an executive order aimed at streamlining the overburdened kidney care and transplantation system—a move meant to “bring new hope to millions of Americans suffering from kidney disease,” Trump said. The policy is intended to improve kidney care in three major ways: by emphasizing more effective and convenient treatments; making more kidneys available for transplant; and improving preventive care and education with the goal of reducing the number of people who develop end-stage renal disease by 25% by 2030. Kidney disease tends not to attract as much attention as o...
Source: TIME: Health - Category: Consumer Health News Authors: Tags: Uncategorized medicine onetime White House Source Type: news
Purpose of review The population of kidney transplant recipients with advanced chronic kidney disease is growing but their outcomes are poor and care is not standardized. There has been wide variety of research in recent years on different aspects of care in failing allografts, and these research findings may help the providers in optimizing care. The purpose of the review is to outline the challenges and opportunities in management of failing allograft, and provide tools for improvement. Recent findings This review summarizes the recent research in field of failing allograft including outcomes, immunosuppression, ris...
Source: Current Opinion in Organ Transplantation - Category: Surgery Tags: KIDNEY PANCREAS: Edited by Matthew Cooper Source Type: research
Pre-publication notice of proposed rule from the Centers for Medicare and Medicaid Services to implement two new mandatory Medicare payment models. The End-Stage Renal Disease (ESRD) Treatment Choices Model (ETC Model) is a mandatory payment model to encourage greater use of home dialysis and kidney transplants. The Radiation Oncology Model (RO Model) promotes quality and financial accountability for providers and suppliers of radiotherapy and tests whether making prospective episode payments to hospital outpatient departments and freestanding radiation therapy centers improves quality of care and reduces Medicare spending...
Source: Federal Register updates via the Rural Assistance Center - Category: Rural Health Source Type: news
GRAFTON (CBS) – President Donald Trump singed an executive order Wednesday, revamping the whole approach to treating kidney disease in this country. And a 19-year-old from Grafton is among the 30 million Americans who could benefit. “I just try to keep busy,” said Samantha Cleveland, “so I don’t focus on why I feel so terrible.” Samantha still battles through chronic fatigue to ride her horse, but is well aware that thousands of people die every year waiting for a kidney. “I try not to think about it,” she said, “because right now I’m doing OK.” Samantha Cle...
Source: WBZ-TV - Breaking News, Weather and Sports for Boston, Worcester and New Hampshire - Category: Consumer Health News Authors: Tags: Boston News Health Syndicated Local Donald Trump Grafton News Ken MacLeod kidney donor Source Type: news
by Craig Klugman, Ph.D. Few people would say that the system of payment and organ distribution is perfect. About 37 million Americans suffer from kidney disease and 94,831 are candidates (as of July 10, 2019) for kidney transplant. In 2018, 21,167 kidney transplants and 836 combined kidney/pancreas transplants were performed in the U.S. Many ESRD patients (468,000) receive dialysis treatment, usually in privately owned clinics, while 193,000 have received a transplant. The system of distribution of kidneys was changed a year ago, when the system sought to increase the number of successful transplants by decreasing the amou...
Source: blog.bioethics.net - Category: Medical Ethics Authors: Tags: Clinical Trials & Studies Featured Posts Health Care Health Regulation & Law HIV/AIDS Informed Consent Organ Transplant & Donation Privacy Public Health Source Type: blogs
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