Patients on maintenance dialysis with a Family History of Kidney Disease have higher Transplant - PowerPoint Presentation

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Patients on maintenance dialysis with a Family History of Kidney Disease have higher Transplant Knowledge

IntroductionKidney transplantation (KT) is the best renal replacement therapy for many patients with End Stage Kidney Disease (ESKD) Knowledge about KT helps patients make more informed treatment decisionsMore transplant related knowledge allows patients to have a better understanding of the benefits of transplantation vs. remaining on dialysisAllows patients to understand and effectively navigate the transplant waitlist processHelps patients to identify and secure potential living donorsFamily and friends who have had previous encounters with a particular disease can participate in sharing their experiences. This has shown to contribute to knowledge acquisition related to the particular condition Getting a better understanding of the disease can assist patients in illness and self-management, as well as making informed healthcare decisionsAmong patients with ESKD however, the association between having family history of kidney disease & kidney transplant knowledge has not yet been documented.

Results

Method

Convenience sample from cross sectional studies enrolling patients with ESKD recruited at Toronto General Hospital, St. Michael’s Hospital and Humber River Hospital. Family history of kidney disease, socio-demographic data and clinical information were collected using a tablet-based electronic data capture system and medical recordsTransplant knowledge score was determined through patient reported answers to 15 transplant specific questionsAnalysisUnivariable associations were tested using t test or chi-squared tests (Table 1 and Table 2) Multivariable adjusted logistic regression models were used to assess the association between the exposure and outcome variables (outcome variable grouping shown in Figure 3)Multiple imputation with chained equations was used to handle missingness. All analysis was done using STATA14Variables

ReferencesFacing the Facts: Includes Highlights from the Canadian Organ Replacement Register. The Kidney Foundation of Canada, 2017, www.kidney.ca/document.doc?id=10459Jones, J, et al. “Health Literacy, Knowledge, and Patient Satisfaction Before Kidney Transplantation.” Transplantation Proceedings., U.S. National Library of Medicine, Oct. 2016,www.ncbi.nlm.nih.gov/pubmed/27788790.“Kidney Disease Statistics for the United States.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, 1 Dec. 2016, www.niddk.nih.gov/health- information/health- statistics/kidney- disease.Reblin, Maija, and Bert N. Uchino. Social and Emotional Support and Its Implication for Health. Mar. 2008, www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/.AcknowledgementsEveryone within the Mucsi – Novak Kidney Health Education and Research Group has been tremendously helpful in gathering dataThe Canadian Society of Nephrology for presenting us with this wonderful opportunity

AIMThe purpose of this study was to determine whether family history of kidney disease is associated with higher kidney transplant knowledge

ConclusionsPatients with family history of kidney disease demonstrated higher transplant related knowledge than patients without This demonstrates the importance of having a close support system in assisting with understanding kidney disease and the different treatment options available to patients Potentially incorporating support networks (family and friends) into the patient education process may improve knowledge acquisition and eventually access to transplantation This can reduce the stress associated with understanding the waitlist processPatients will be more informed about the most effective treatment option for ESKD (living donor transplantation)NEXT STEPSFocus on creating unique approaches to help facilitate engagement between patients and family members or other individuals who have experiential knowledge about kidney disease or kidney transplant to increase awareness of kidney disease and access to transplantationLIMITATIONSRelatively small sample size Cross sectional design cannot determine causal relationships and reduces generalizability

Table 1: Baseline socio-demographic data

CONTACT INFORMATIONLocation: Toronto General Hospital: 585 University Ave, Toronto, ON M5G 2N2Email: Istvan.Mucsi@uhn.ca

M. KHALID1, O. EKUNDAYO1, N. SINGH1, V. GUPTA1, Y. LIAO1, M. OMRAN1 and I. MUCSI1 1Multi-Organ Transplant Program and Division of Nephrology, University Health Network, Toronto, Canada

Baseline Characteristic

Family History of Kidney DiseaseP-valueNoYesTotal(N = 289)(N = 136)(N = 425)Age in years (SD)58 + 1356 + 1357 + 130.243 Sex   0.08Male185 (64%)75 (55%)260 (61%) Education Level   0.054Less than 12 yrs211 (77%)87(68%)298(74%) Ethnicity   0.508White117 (44%)52 (41%)169 (43%)Non-White146 (56%)75 (59%)221(57%) Income Categories   0.193< 30 per year103 (52%)44 (44%)147 (49%)>30 per year97 (48%)57 (56%)154 (51%) Marital Status   0.919Single65 (23%)28 (21%)93 (22%)Married/Common-law135 (48%)65 (49%)200 (48%)Divorced/Seperated/Widow83 (29%)39 (30%)122 (29%) Charlson Comorbidity Index (median[IQR])4[3]3[2]3[3]0.026Duration on Dialysis    0.9742 years or Less100 (48%)46 (47%)146 (48%)

Meet exclusion criteria

(n=250)

Figure 1: Enrollment process - highlighting how final cohort of 425 patients was obtained

Removed (n=27)

Outcome: transplant knowledge score (TKS)

Self reported and assessed using 15 true/false and multiple – choice questions to generate a 15 point scale

Range:0 (low TKS) 15 (high TKS)Divided into tertiles  regrouped into two groups (median)

LowMediumHigh

Potential Confounding:

age, gender, ethnicity, income, marital status, educational levels, Charlson Comorbidity Index Scores, duration of time on dialysis

Exposure: family history of kidney diseaseDoes anyone in your immediate family have kidney disease (yes/no)Self reported by patients in questionnaire

Family History of Kidney DiseaseMean KT Knowledge ScoreStandard DeviationP ValueYes7.03.00.016No6.23.0

Table 2: Mean transplant knowledge scores of those with/without family history of kidney disease

ModelPositive Family History Odds Ratio [ CI ]P - valueI1.70 [1.12 – 2.56] 0.012II1.71 [1.11 – 2.64] 0.015III1.58 [1.02 – 2.46] 0.042IV1.58 [1.01 – 2.46] 0.044

Model I: Univariable modelModel II: Model I +Age, Sex, EthnicityModel III: Model II + Income, marital status, Education levelModel IV : Model III + CCI Score + Dialysis vintage

Table 3: Multivariable logistic regression assessing the association between transplant knowledge and family history of kidney disease

Figure 3:

Transplant knowledge scores were grouped into two groups using the median knowledge score. Individuals with a family history of kidney disease were significantly more likely to demonstrate high transplant knowledge (p=0.012).

Physician diagnosis of dementia Severe / acute illness Unable to read/understand grade 5 English Unwilling to provide consent

Missing exposure variable

Patients Considered (n=702)Convenience sample of adult patients with ESKD considered from several dialysis clinics in Toronto Inclusion Criteria:18 – 80 years oldDialysis > 3 monthsPatients with ESKD

Final Cohort (n=425)

LowHigh