{"id":16939,"date":"2023-11-03T12:48:02","date_gmt":"2023-11-03T16:48:02","guid":{"rendered":"https:\/\/www.ices.on.ca\/?post_type=journal_article&#038;p=16939"},"modified":"2023-11-03T12:48:49","modified_gmt":"2023-11-03T16:48:49","slug":"effect-of-a-novel-multicomponent-intervention-to-improve-patient-access-to-kidney-transplant-and-living-kidney-donation-the-enakt-lkd-cluster-randomized-clinical-trial","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/effect-of-a-novel-multicomponent-intervention-to-improve-patient-access-to-kidney-transplant-and-living-kidney-donation-the-enakt-lkd-cluster-randomized-clinical-trial\/","title":{"rendered":"Effect of a novel multicomponent intervention to improve patient access to kidney transplant and living kidney donation: the ENAKT LKD cluster randomized clinical trial"},"content":{"rendered":"<p><strong>Importance<\/strong> \u2014\u00a0Patients with advanced chronic kidney disease (CKD) have the best chance for a longer and healthier life if they receive a kidney transplant. However, many barriers prevent patients from receiving a transplant.<\/p>\n<p><strong>Objectives<\/strong> \u2014\u00a0To evaluate the effect of a multicomponent intervention designed to target several barriers that prevent eligible patients from completing key steps toward receiving a kidney transplant.<\/p>\n<p><strong>Design, Setting, and Participants<\/strong> \u2014\u00a0This pragmatic, 2-arm, parallel-group, open-label, registry-based, superiority, cluster randomized clinical trial included all 26 CKD programs in Ontario, Canada, from November 1, 2017, to December 31, 2021. These programs provide care for patients with advanced CKD (patients approaching the need for dialysis or receiving maintenance dialysis).<\/p>\n<p><strong>Interventions<\/strong> \u2014\u00a0Using stratified, covariate-constrained randomization, allocation of the CKD programs at a 1:1 ratio was used to compare the multicomponent intervention vs usual care for 4.2 years. The intervention had 4 main components, (1) administrative support to establish local quality improvement teams; (2) transplant educational resources; (3) an initiative for transplant recipients and living donors to share stories and experiences; and (4) program-level performance reports and oversight by administrative leaders.<\/p>\n<p><strong>Main Outcomes and Measures<\/strong> \u2014\u00a0The primary outcome was the rate of steps completed toward receiving a kidney transplant. Each patient could complete up to 4 steps: step 1, referred to a transplant center for evaluation; step 2, had a potential living donor contact a transplant center for evaluation; step 3, added to the deceased donor waitlist; and step 4, received a transplant from a living or deceased donor.<\/p>\n<p><strong>Results<\/strong> \u2014\u00a0The 26 CKD programs (13 intervention, 13 usual care) during the trial period included 20\u202f375 potentially transplant-eligible patients with advanced CKD (intervention group [n\u2009=\u20099780 patients], usual-care group [n\u2009=\u200910\u202f595 patients]). Despite evidence of intervention uptake, the step completion rate did not significantly differ between the intervention vs usual-care groups: 5334 vs 5638 steps; 24.8 vs 24.1 steps per 100 patient-years; adjusted hazard ratio, 1.00 (95% CI, 0.87-1.15).<\/p>\n<p><strong>Conclusions and Relevance<\/strong> \u2014\u00a0This novel multicomponent intervention did not significantly increase the rate of completed steps toward receiving a kidney transplant. Improving access to transplantation remains a global priority that requires substantial effort.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Importance \u2014\u00a0Patients with advanced chronic kidney disease (CKD) have the best chance for a longer and healthier life if they receive a kidney transplant. However, many barriers prevent patients from receiving a transplant. Objectives \u2014\u00a0To evaluate the effect of a multicomponent intervention designed to target several barriers that prevent eligible patients from completing key steps [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[42,49,60],"migration-helper-qa-sample-set":[],"class_list":["post-16939","journal_article","type-journal_article","status-publish","hentry","topic-chronic-diseases-and-multimorbidity","topic-kidney-disease","topic-policy-and-program-evaluation"],"acf":{"citation":"Garg AX, Yohanna S, Naylor KL, McKenzie SQ, Mucsi I, Dixon SN, Luo B, Sontrop JM, Beaucage M, Belenko D, Coghlan C, Cooper R, Elliott L, Getchell L, Heale E, Ki V, Nesrallah G, Patzer RE, Presseau J, Reich M, Treleaven D, Wang C, Waterman AD, Zaltzman J, Blake PG. <em>JAMA Intern Med<\/em>. 2023; Nov 3 [Epub ahead of print].","source_url":"https:\/\/doi.org\/doi:10.1001\/jamainternmed.2023.5802","ices_scientist":[1242,1208,1299],"site":[6739],"research_program":[6743],"news_release":[16940],"journal_article":"","atlas":"","research_report":"","infographic":[16944,16943],"video":"","downloads":null,"links":null,"sitecore_item_id":"","sitecore_item_name":"","sitecore_field_values":"","previous_url":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Effect of a novel multicomponent intervention to improve patient access to kidney transplant and living kidney donation: the ENAKT LKD cluster randomized clinical trial<\/title>\n<meta name=\"description\" content=\"Importance \u2014\u00a0Patients with advanced chronic kidney disease (CKD) have the best chance for a longer and healthier life if they receive a kidney transplant.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, 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