Public Release: 

$6.7 million project aims to improve dialysis care

University of Michigan

ANN ARBOR--Helping kidney dialysis patients have healthier treatment sessions and longer lives is the goal of a new $6.7 million project at the University of Michigan.

Tiffany Veinot, associate professor at the School of Information and School of Public Health, will receive funding for the work from the Patient-Centered Outcomes Research Institute. Dr. Rajiv Saran, professor of internal medicine and epidemiology at the Medical School and School of Public Health, and associate director of the Kidney Epidemiology and Cost Center, will co-lead the study.

The project will educate both patients and their medical teams on how to make dialysis sessions safer for patients. Hemodialysis therapy is the most common treatment for the end-stage renal disease, a condition in which a person's kidneys stop working. In dialysis, a machine does the organs' job removing fluid and waste from the body. It typically requires patients to sit in a clinic for four hours at a time three days a week.

Often, these sessions become unstable. Patients experience low blood pressure or other complications. Aside from the fatigue that goes along with it, unstable sessions are linked to heart problems and death. Session instability is therefore an important patient safety problem.

None of that has to happen, though, Veinot says. Session instability is largely preventable. Usually it happens when dialysis facility staff remove too much fluid or do so too quickly.

"Session instability results from many factors: decisions made by patients, decisions by health care providers and dialysis clinic policies." Veinot said. "Our project targets all of these with educational interventions."

Patients in the study will attend six peer-mentoring sessions that aim to support behavior change. The sessions, provided through a partnership with the National Kidney Foundation, will encourage patients to eat a healthy, low-salt diet; drink appropriate amounts of fluid; stay at the dialysis clinic for the full length of sessions; if necessary, stay longer to allow staff to take fluid out at the right rate; work with doctors and nurses to make decisions about care; and notice and quickly report the dizziness and cramping that could signal session instability.

Medical professionals in the study will receive online education, team training and checklists aimed at helping them: regularly checking patients' fluid status; revisiting patients' fluid removal targets and treatment times more frequently; involving patients in making decisions; making sure the rate of fluid removal stays at a safe level; and responding quickly to session instability.

"It is important to fundamentally change the culture at dialysis facilities, where all too often the focus is to reach the minimum necessary treatment goals without a comprehensive strategy for fluid management," Saran said. "Such a strategy should include reaching an optimum weight at the end of the dialysis treatment without undue stress to the cardiovascular system and other vital organs such as the brain and gut. A lot of distress to patients, hospital admissions and deaths could be avoided if greater attention is paid to this critical aspect of patient care."

The study is unique, the researchers say, in that it's a clinical trial comparing the effectiveness of two educational approaches--peer mentoring and provider education.

"National and international organizations have called for patient involvement in safety enhancement efforts in health care," Veinot said. "Yet, efforts to promote patient involvement in safety activities have had mixed success in changing behavior."

She believes this is due to researchers' assumptions about patients' abilities to help keep themselves safer without adequate education and support. This study gives patients that support and it also examines the potential for patients to help each other stay healthier through peer mentoring sessions.

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Other collaborators, in addition to the project leaders, include: Kai Zheng and Brenda Gillespie of the School of Public Health; Dr. Michael Heung, Jennifer Bragg-Gresham and Sarah Krein of the Medical School; patient partners Norman Bash and Bill Dant; and organizational partners the National Kidney Foundation, Renal Research Institute, Fresenius Medical Care and Five Diamond Patient Safety Program.

PCORI is an independent, nonprofit organization authorized by Congress through the Affordable Care Act in 2010. It funds research designed to provide patients, their caregivers, and clinicians evidence-based information to help them make better-informed healthcare decisions. PCORI's Board has approved this award to the University of Michigan pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.

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