Educational Interventions for CKD Patients

Despite the increasing global burden of chronic kidney disease (CKD), there remains a paucity of targeted therapies that slow CKD progression. Patients with CKD are at increased risk of morbidity and mortality from cardiovascular disease, and management of cardiovascular risk remains the mainstay of CKD management.  Appropriately, there has been considerable focus on pharmacologic therapies that may modify cardiovascular risk and delay CKD progression.  Considerably fewer studies have targeted educational interventions that may influence patient-reported and clinical outcomes in CKD patients.

Lopez-Vargas et al conducted a systematic review that explored educational interventions for patients with CKD, and identified characteristics of the more effective interventions.  Educational intervention studies (12 trials, 14 observational studies) in patients with CKD stages 1 to 5 (excluding studies including patients with CKD 5 only or end-stage renal disease [ESRD]) were included.  Unsurprisingly, studies were heterogeneous in nature, and it was not feasible to perform a meta-analysis.  Many of the included studies were of poor quality with high risk of bias, and some studies used inappropriate methods to measure outcomes.

While some studies reported improvements in patient-reported and clinical outcomes, there is perhaps more to be learned from studying features of interventions that appeared to work.  Characteristics of effective interventions included interactive teaching sessions, integrated negotiated goal-setting, involved patients, their families, and a multi-disciplinary team, and had frequent patient/educator encounters.  However, it remains unclear why these characteristics are important and in what contexts, limiting the generalizability of these findings.

The authors call for further research to develop high-quality educational interventions for CKD patients.  Outcome measures need to be evaluated appropriately, and assessed by individuals not directly involved in the development or delivery of the intervention.  It is likely that a blended educational format with opportunity for reinforcement of key concepts is ideal, though consideration needs to be given to sustainability of approaches involving multiple educator/patient sessions beyond trial contexts.

The authors note that only five studies had interventions that were based on theoretical frameworks.  These included the trans-theoretical model, health belief model, and self-regulation theory.  Conducting studies that are informed by well-established educational theory and drawn from the wider educational literature may help develop our understanding of how and why educational interventions may be effective.  Theoretically informed mixed-methods and qualitative studies that aim to understand how and why educational interventions influence outcomes would also improve our understanding of this complex and under-researched subject.

Post written by Dr. Iain Drummond, Nephrology Fellow, Royal Infirmary of Edinburgh, and edited by Dr. Paul Phelan, AJKD Blog Contributor.

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