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. 2021 Jul;32(7):1791-1800.
doi: 10.1681/ASN.2020091254. Epub 2021 Apr 15.

Effects of a Knowledge-Translation Intervention on Early Dialysis Initiation: A Cluster Randomized Trial

Navdeep Tangri  1   2 , Amit X Garg  3   4   5 , Thomas W Ferguson  1   2 , Stephanie Dixon  3   5 , Claudio Rigatto  1   2 , Selina Allu  6   7 , Elaine Chau  1   2 , Paul Komenda  1   2 , David Naimark  8 , Gihad E Nesrallah  5   9 , Steven D Soroka  10   11 , Monica Beaulieu  12   13 , Ahsan Alam  14 , S Joseph Kim  8 , Manish M Sood  15 , Braden Manns  6   7
Affiliations

Effects of a Knowledge-Translation Intervention on Early Dialysis Initiation: A Cluster Randomized Trial

Navdeep Tangri et al. J Am Soc Nephrol. 2021 Jul.

Abstract

Background: The Initiating Dialysis Early and Late (IDEAL) trial, published in 2009, found no clinically measurable benefit with respect to risk of mortality or early complications with early dialysis initiation versus deferred dialysis start. After these findings, guidelines recommended an intent-to-defer approach to dialysis initiation, with the goal of deferring it until clinical symptoms arise.

Methods: To evaluate a four-component knowledge translation intervention aimed at promoting an intent-to-defer strategy for dialysis initiation, we conducted a cluster randomized trial in Canada between October 2014 and November 2015. We randomized 55 clinics, 27 to the intervention group and 28 to the control group. The educational intervention, using knowledge-translation tools, included telephone surveys from a knowledge-translation broker, a 1-year center-specific audit with feedback, delivery of a guidelines package, and an academic detailing visit. Participants included adults who had at least 3 months of predialysis care and who started dialysis in the first year after the intervention. The primary efficacy outcome was the proportion of patients who initiated dialysis early (at eGFR >10.5 ml/min per 1.73 m2). The secondary outcome was the proportion of patients who initiated in the acute inpatient setting.

Results: The analysis included 3424 patients initiating dialysis in the 1-year follow-up period. Of these, 509 of 1592 (32.0%) in the intervention arm and 605 of 1832 (33.0%) in the control arm started dialysis early. There was no difference in the proportion of individuals initiating dialysis early or in the proportion of individuals initiating dialysis as an acute inpatient.

Conclusions: A multifaceted knowledge translation intervention failed to reduce the proportion of early dialysis starts in patients with CKD followed in multidisciplinary clinics.

Clinical trial registry name and registration number: ClinicalTrials.gov, NCT02183987. Available at: https://clinicaltrials.gov/ct2/show/NCT02183987.

Keywords: chronic dialysis; clinical trial; glomerular filtration rate; hospitalization; kidney failure; randomized controlled trials.

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Figures

Figure 1.
Figure 1.
Overview of knowledge translation, audit and feedback, medical detailing, and ongoing follow-up. KT, knowledge translation.
Figure 2.
Figure 2.
Overview of randomization, intervention assignment, exclusion criteria, and follow-up.
See this image and copyright information in PMC

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