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Kidney Int. 2014 Mar;85(3):686-92. doi: 10.1038/ki.2013.369. Epub 2013 Sep 25.

Educational programs improve the preparation for dialysis and survival of patients with chronic kidney disease.

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1] VA Palo Alto Health Care System, Geriatrics Research Education and Clinical Center, Palo Alto, California, USA [2] Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA.
Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minneapolis, USA.
Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Research Service, Harry S Truman Memorial Veterans Hospital and Division of Nephrology and Hypertension, University of Missouri-Columbia School of Medicine, Columbia, Missouri, USA.
St John Providence Health System, Providence Park Heart Institute, Novi, Michigan, USA.
Harborview Medical Center and Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington, USA.


Preparation for end-stage renal disease (ESRD) is widely acknowledged to be suboptimal in the United States. We sought to determine whether participation in a kidney disease screening and education program resulted in improved ESRD preparation and survival in 595 adults who developed ESRD after participating in the National Kidney Foundation Kidney Early Evaluation Program (KEEP), a community-based screening and education program. Non-KEEP patients were selected from a national ESRD registry and matched to KEEP participants based on demographic and clinical characteristics. The main outcomes were pre-ESRD nephrologist care, placement of permanent vascular access, use of peritoneal dialysis, pre-emptive transplant wait listing, transplantation, and mortality after ESRD. Participation in KEEP was associated with significantly higher rates of pre-ESRD nephrologist care (76.0% vs. 69.3%), peritoneal dialysis (10.3% vs. 6.4%), pre-emptive transplant wait listing (24.2% vs. 17.1%), and transplantation (9.7% vs. 6.4%) but not with higher rates of permanent vascular access (23.4% vs. 20.1%). Participation in KEEP was associated with a lower risk for mortality (hazard ratio 0.80), but this was not statistically significant after adjusting for ESRD preparation. Thus, participation in a voluntary community kidney disease screening and education program was associated with higher rates of ESRD preparation and survival.

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