# A Patient-centered, System-based Approach to Improve Informed Dialysis Choice and Outcomes in Veterans with CKD

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2024 · —

## Abstract

Background: CKD is the 4th most common diagnosis among Veterans. Each year 13,000 Veterans transition
to ESRD. VHA supports over 52,000 ESRD Veterans on dialysis. The care of CKD costs VHA over $18 billion
dollars annually. Transition care of these Veterans is uncoordinated and suboptimal as most receive their pre-
ESRD care within VHA but over 90% are outsourced for their dialysis, on fee-basis. Thus, the majority of
Veterans progressing to ESRD have limited awareness of CKD and its management options including the
dialysis modalities. This leads to gross underuse (7%) of home dialysis (HoD). Professional renal societies and
VHA national CKD program advocate informed dialysis choice, and greater use of HoD for all patients
transitioning to ESRD. European and Canadian reports show that CPE empowers informed choice of dialysis,
increases HoD use, and improves the quality of CKD care. However, availability of CPE within VHA is limited
and HoD utilization is low. To address these issues, we have developed and pilot-tested a concise CPE model
in two different universities and affiliated VA in Florida and Arkansas. Our preliminary findings show that CPE
improves patient informed dialysis choice, and increases HoD selection to 74% and HoD use to 61%. In a
separate pilot study, we found that tele-CPE is as efficacious as F2F-CPE. Objectives: The overall goal of this
RCT is to investigate the impact of CPE on patient knowledge and confidence, HoD selection and use, and
patient-reported, health services and clinical outcomes in a cohort of Veterans who were diagnosed with CKD
and receive CKD treatment from the North Florida/South Georgia Veterans Health System (NF/SG VHS). The
study aligns with HSR&D major research priorities including “patient-centered care, care management, and
health promotion” and “health care systems change.” The 4 Specific Aims are: Aim 1: Compare the impact of
CPE on Veterans’ knowledge of CKD, their confidence in dialysis decision making, and their selection of
dialysis modality, between the CPE and usual care groups. Aim 2: Compare Veterans’ actual use of HoD
(Primary Outcome) between the CPE and usual care groups. Aim 3: Examine Veterans’ perceived satisfaction
with CPE, explore their preferences for F2F- or Tele-CPE, and investigate barriers and facilitators in the
selection and use of their preferred dialysis modality. (Qualitative) Aim 4: Compare the following post-ESRD
secondary outcomes between the CPE and usual care groups. Patient reported outcomes: 1) health-related
quality of life and 2) satisfaction with dialysis; clinical outcomes: 3) time to ESRD, 4) estimated glomerular
filtration rate at ESRD, 5) need for inpatient initiation of dialysis, and 6) vascular access status at ESRD; and
health services utilization outcomes: 7) number of inpatient stays, and 8) number of outpatient visits, from
enrollment to 90-day post ESRD period. Methods: In this mixed method RCT, we will enroll 800 Veterans with
stage 4 or 5 CKD, ≥18 ...

## Key facts

- **NIH application ID:** 11087452
- **Project number:** 5I01HX002639-05
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Huanguang Jia
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-03-01 → 2026-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11087452

## Citation

> US National Institutes of Health, RePORTER application 11087452, A Patient-centered, System-based Approach to Improve Informed Dialysis Choice and Outcomes in Veterans with CKD (5I01HX002639-05). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/11087452. Licensed CC0.

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