Transplant Trial Watch

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

Waterman, A. D., et al. (2019).

American Journal of Kidney Diseases 74(5): 640-649.


Aims
This study aimed to evaluate whether an 8-month Explore Transplant @ Home education program, with or without telephonic support from an educator, could help improve transplantation knowledge, informed decision-making, pro-transplantation attitudes and steps toward kidney transplantation compared to traditional dialysis center kidney transplantation for low-income black and white patients.

Interventions
Patients were randomly assigned to one of 3 inerventions: patient-guided intervention and standard care, educator-guided intervention and standard care or standard of care only.

Participants
561 black and white dialysis patients from Missouri.

Outcomes
The primary otucome being assessed was patients’ knowledge of living donor kidney transplantation (LDKT) and deceased donor kidney transplantation (DDKT). Secondary outcomes included informed decision making, LDKT and DDKT attitudes and new steps towards transplantation.

Follow-up
8 months

CET Conclusions
The RCT evaluated the efficacy of three educational interventions in black and white, low-income dialysis patients to increase knowledge of living and deceased donor kidney transplantation. Patients (n=561) were randomly allocated to standard of care, Explore Transplant @Home patient-guided education or Explore Transplant @Home educator-guided education. The sample size calculation showed that 150 patients per arm were needed to achieve 80% power. The modified intention to treat analysis included all patients who completed the study and included 456 patients and the per-protocol analysis included 369 patients. Groups were comparable at baseline. There were significant increases in transplantation knowledge in the educator- and patient-guided intervention arms compared with standard of care. Higher proportions of patients in the educator- and patient-guided intervention arms were able to make informed decisions. Patients in all groups took new steps towards transplantation compared to baseline. Exploratory analyses were conducted to identify differences in the effects within subgroups of patients.

Jadad score
2

Data analysis
Modified intention-to-treat analysis

Allocation concealment
No

Trial registration
ClinicalTrials.gov - NCT02268682

Funding source
Industry funded