Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Feb 12;22(2):e17194.
doi: 10.2196/17194.

A Virtual Multidisciplinary Care Program for Management of Advanced Chronic Kidney Disease: Matched Cohort Study

Paulina Kaiser  1 , Olivia Pipitone  1 , Anthony Franklin  1 , Dixie R Jackson  1 , Elizabeth A Moore  1 , Christopher R Dubuque  1 , Carmen A Peralta  2   3 , Anthony C De Mory  1
Affiliations

A Virtual Multidisciplinary Care Program for Management of Advanced Chronic Kidney Disease: Matched Cohort Study

Paulina Kaiser et al. J Med Internet Res. .

Abstract

Background: It is not well established whether a virtual multidisciplinary care program for persons with advanced chronic kidney disease (CKD) can improve their knowledge about their disease, increase their interest in home dialysis therapies, and result in more planned outpatient (versus inpatient) dialysis starts.

Objective: We aimed to evaluate the feasibility and preliminary associations of program participation with disease knowledge, home dialysis modality preference, and outpatient dialysis initiation among persons with advanced CKD in a community-based nephrology practice.

Methods: In a matched prospective cohort, we enrolled adults aged 18 to 85 years with at least two estimated glomerular filtration rates (eGFRs) of less than 30 mL/min/1.73 m2 into the Cricket Health program and compared them with controls receiving care at the same clinic, matched on age, gender, eGFR, and presence of heart failure and diabetes. The intervention included online education materials, a virtual multidisciplinary team (nurse, pharmacist, social worker, dietician), and patient mentors. Prespecified follow-up time was nine months with extended follow-up to allow adequate time to determine the dialysis start setting. CKD knowledge and dialysis modality choice were evaluated in a pre-post survey among intervention participants.

Results: Thirty-seven participants were matched to 61 controls by age (mean 67.2, SD 10.4 versus mean 68.8, SD 9.5), prevalence of diabetes (54%, 20/37 versus 57%, 35/61), congestive heart failure (22%, 8/37 versus 25%, 15/61), and baseline eGFR (mean 19, SD 6 versus mean 21, SD 5 mL/min/1.73 m2), respectively. At nine-month follow-up, five patients in each group started dialysis (P=.62). Among program participants, 80% (4/5) started dialysis as an outpatient compared with 20% (1/5) of controls (OR 6.28, 95% CI 0.69-57.22). In extended follow-up (median 15.7, range 11.7 to 18.1 months), 19 of 98 patients started dialysis; 80% (8/10) of the intervention group patients started dialysis in the outpatient setting versus 22% (2/9) of control patients (hazard ratio 6.89, 95% CI 1.46-32.66). Compared to before participation, patients who completed the program had higher disease knowledge levels (mean 52%, SD 29% versus mean 94%, SD 14% of questions correct on knowledge-based survey, P<.001) and were more likely to choose a home modality as their first dialysis choice (36%, 7/22 versus 68%, 15/22, P=.047) after program completion.

Conclusions: The Cricket Health program can improve patient knowledge about CKD and increase interest in home dialysis modalities, and may increase the proportion of dialysis starts in the outpatient setting.

Keywords: chronic kidney disease; end-stage renal disease; online social networking; patient education; renal dialysis.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: CAP is the chief medical officer for Cricket Health. She consulted on the study design, interpretation of results, and contributed to manuscript writing, but was not involved in recruitment or data collection. CRD completed the physician-adjudication process for dialysis outcome data. CRD was blinded to the intervention and had no affiliation with Cricket Health, but was paid by Cricket Health for his time spent doing manual data collection. Cricket Health and Samaritan Health Services entered a financial relationship after study completion. ADM's spouse is a paid consultant for the Cricket Health program. All other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Patient flow diagram. *Two patients later died. **One patient later died.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Saran Rajiv, Robinson Bruce, Abbott KC, Agodoa LY, Bragg-Gresham J, Balkrishnan R, Bhave N, Dietrich X, Ding Z, Eggers PW, Gaipov A, Gillen D, Gipson D, Gu H, Guro P, Haggerty D, Han Y, He K, Herman W, Heung M, Hirth RA, Hsiung J, Hutton D, Inoue A, Jacobsen SJ, Jin Y, Kalantar-Zadeh K, Kapke A, Kleine C, Kovesdy CP, Krueter W, Kurtz V, Li Y, Liu S, Marroquin MV, McCullough K, Molnar MZ, Modi Z, Montez-Rath M, Moradi H, Morgenstern H, Mukhopadhyay P, Nallamothu B, Nguyen DV, Norris KC, O'Hare AM, Obi Y, Park C, Pearson J, Pisoni R, Potukuchi PK, Repeck K, Rhee CM, Schaubel DE, Schrager J, Selewski DT, Shamraj R, Shaw SF, Shi JM, Shieu M, Sim JJ, Soohoo M, Steffick D, Streja E, Sumida K, Kurella Tamura M, Tilea A, Turf M, Wang Dongyu, Weng W, Woodside KJ, Wyncott A, Xiang J, Xin X, Yin M, You AS, Zhang X, Zhou H, Shahinian V. US Renal Data System 2018 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2019 Mar;73(3S1):A7–A8. doi: 10.1053/j.ajkd.2019.01.001. http://europepmc.org/abstract/MED/30798791 - DOI - PMC - PubMed
    1. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu C. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004 Dec 23;351(13):1296–1305. doi: 10.1056/NEJMoa041031. - DOI - PubMed
    1. Garg AX, Suri RS, Eggers P, Finkelstein FO, Greene T, Kimmel PL, Kliger AS, Larive B, Lindsay RM, Pierratos A, Unruh M, Chertow GM, Frequent Hemodialysis Network Trial Investigators Patients receiving frequent hemodialysis have better health-related quality of life compared to patients receiving conventional hemodialysis. Kidney Int. 2017 Mar;91(3):746–754. doi: 10.1016/j.kint.2016.10.033. https://linkinghub.elsevier.com/retrieve/pii/S0085-2538(16)30647-0 - DOI - PMC - PubMed
    1. Ghaffari A, Kalantar-Zadeh K, Lee J, Maddux F, Moran J, Nissenson A. PD First: peritoneal dialysis as the default transition to dialysis therapy. Semin Dial. 2013;26(6):706–713. doi: 10.1111/sdi.12125. - DOI - PubMed
    1. Liu HH, Zhao S. Savings opportunity from improved CKD care management. J Am Soc Nephrol. 2018 Nov;29(11):2612–2615. doi: 10.1681/ASN.2017121276. http://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=30279275 - DOI - PMC - PubMed