Abstract
BackgroundLiving donor kidney transplantation (LDKT) is the most successful form of renal replacement therapy in terms of wait time and survival rates. However, we observed a significant inequality in the number of LDKT performed between the Dutch and the non-Dutch patients. The objective of this study is to adapt, implement and test an educational home-based intervention to contribute to the reduction of this inequality. Our aim is to establish this through guided communication together with the social network of the patients in an attempt that well-informed decisions regarding renal replacement therapy can be made: Multisystemic Engagement & Nephrology. This manuscript is a detailed description of the Kidney Team At Home-study protocol.Methods and designAll patients (>18 yrs) that are referred to the pre-transplantation outpatient clinic are eligible to participate in the study. Patients will be randomly assigned to either an experimental or a control group. The control group will continue to receive standard care. The experimental group will receive standard care plus a home-based educational intervention. The intervention consists of two sessions at the patient’s home, an initial session with the patient and a second session for which individuals from their social network are invited to take part. Based on the literature and behavioural change theories we hypothesize that reducing hurdles in knowledge, risk perception, subjective norm, self-efficacy, and communication contribute to well-informed decision making and reducing inequality in accessing LDKT programs. A change in these factors is consequently our primary outcome-measure. Based on power calculations, we aim to include 160 patients over a period of two years.DiscussionIf we are able to show that this home-based group educational intervention contributes to 1) achieving well-informed decision regarding treatment and 2) reducing the inequality in LDKT, the quality of life of patients will be improved while healthcare costs are reduced. As the intervention is investigated in a random heterogeneous patient group in daily practice, the transfer to clinical practice in other kidney transplant centers should be relatively easy.Trial registrationNetherlands Trial Register, NTR2730.
Highlights
The purpose of the Kidney Team At Home-studyAn introduction to kidneys and kidney diseasesThe various forms of dialysisMorbidity and mortality associated with dialysisThe psychosocial consequences of a kidney disease and dialysisThe advantages and disadvantages of dialysis compared to kidney transplantationThe medical evaluation in preparation for donor nephrectomy and kidney transplantationThe various programs of donation and transplantation (DDKT and Living donor kidney transplantation (LDKT))The number of deceased donor kidney transplantation (DDKT) and LDKT performed nationally and locallyThe differences in ethnicity regarding access to LDKTThe differences in graft survival between DDKT and LDKT
If we are able to show that this home-based group educational intervention contributes to 1) achieving well-informed decision regarding treatment and 2) reducing the inequality in LDKT, the quality of life of patients will be improved while healthcare costs are reduced
Research shows that LDKT is associated with significant patient and graft survival benefits when compared to DDKT [4]
Summary
The purpose of the Kidney Team At Home-studyAn introduction to kidneys and kidney diseasesThe various forms of dialysisMorbidity and mortality associated with dialysisThe psychosocial consequences of a kidney disease and dialysisThe advantages and disadvantages of dialysis compared to kidney transplantationThe medical evaluation in preparation for donor nephrectomy and kidney transplantationThe various programs of donation and transplantation (DDKT and LDKT)The number of DDKT and LDKT performed nationally and locallyThe differences in ethnicity regarding access to LDKTThe differences in graft survival between DDKT and LDKT. Living donor kidney transplantation (LDKT) is the most successful form of renal replacement therapy in terms of wait time and survival rates. Our aim is to establish this through guided communication together with the social network of the patients in an attempt that well-informed decisions regarding renal replacement therapy can be made: Multisystemic Engagement & Nephrology This manuscript is a detailed description of the Kidney Team At Home-study protocol. To determine an adequate sample size for detecting the effect we did a power analysis based on the proportion of LDKT’s performed in the control versus the experimental group in previous research [17] We used this parameter since this is the only one on which there has been reported in the literature with regard to the current study parameters. Calculations were performed in SAS; Power and Sample Size version 3.1
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