Navdeep Tangri1,2, Amit X Garg3,4,5, Thomas W Ferguson6,2, Stephanie Dixon3,5, Claudio Rigatto6,2, Selina Allu7,8, Elaine Chau6,2, Paul Komenda6,2, David Naimark9, Gihad E Nesrallah5,10, Steven D Soroka11,12, Monica Beaulieu13,14, Ahsan Alam15, S Joseph Kim9, Manish M Sood16, Braden Manns7,8. 1. Department of Internal Medicine, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada ntangri@sogh.mb.ca. 2. Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada. 3. Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada. 4. Department of Medicine, Western University, London, Ontario, Canada. 5. Institute for Clinical Evaluative Sciences, London, Ontario, Canada. 6. Department of Internal Medicine, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada. 7. Department of Medicine and Community Health Sciences, Libin Cardiovascular Institute, Calgary, Canada. 8. O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 9. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 10. Division of Nephrology, Humber River Hospital, Toronto, Ontario, Canada. 11. Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. 12. Nova Scotia Health Authority Renal Program, Halifax, Nova Scotia, Canada. 13. Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 14. BC Renal Agency, Vancouver, British Columbia, Canada. 15. Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada. 16. The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Abstract
BACKGROUND: The Initiating Dialysis Early and Late (IDEAL) trial, published in 2009, found no clinically measurable benefit with respect to risk of mortality or early complications with early dialysis initiation versus deferred dialysis start. After these findings, guidelines recommended an intent-to-defer approach to dialysis initiation, with the goal of deferring it until clinical symptoms arise. METHODS: To evaluate a four-component knowledge translation intervention aimed at promoting an intent-to-defer strategy for dialysis initiation, we conducted a cluster randomized trial in Canada between October 2014 and November 2015. We randomized 55 clinics, 27 to the intervention group and 28 to the control group. The educational intervention, using knowledge-translation tools, included telephone surveys from a knowledge-translation broker, a 1-year center-specific audit with feedback, delivery of a guidelines package, and an academic detailing visit. Participants included adults who had at least 3 months of predialysis care and who started dialysis in the first year after the intervention. The primary efficacy outcome was the proportion of patients who initiated dialysis early (at eGFR >10.5 ml/min per 1.73 m2). The secondary outcome was the proportion of patients who initiated in the acute inpatient setting. RESULTS: The analysis included 3424 patients initiating dialysis in the 1-year follow-up period. Of these, 509 of 1592 (32.0%) in the intervention arm and 605 of 1832 (33.0%) in the control arm started dialysis early. There was no difference in the proportion of individuals initiating dialysis early or in the proportion of individuals initiating dialysis as an acute inpatient. CONCLUSIONS: A multifaceted knowledge translation intervention failed to reduce the proportion of early dialysis starts in patients with CKD followed in multidisciplinary clinics. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: ClinicalTrials.gov, NCT02183987. Available at: https://clinicaltrials.gov/ct2/show/NCT02183987.
BACKGROUND: The Initiating Dialysis Early and Late (IDEAL) trial, published in 2009, found no clinically measurable benefit with respect to risk of mortality or early complications with early dialysis initiation versus deferred dialysis start. After these findings, guidelines recommended an intent-to-defer approach to dialysis initiation, with the goal of deferring it until clinical symptoms arise. METHODS: To evaluate a four-component knowledge translation intervention aimed at promoting an intent-to-defer strategy for dialysis initiation, we conducted a cluster randomized trial in Canada between October 2014 and November 2015. We randomized 55 clinics, 27 to the intervention group and 28 to the control group. The educational intervention, using knowledge-translation tools, included telephone surveys from a knowledge-translation broker, a 1-year center-specific audit with feedback, delivery of a guidelines package, and an academic detailing visit. Participants included adults who had at least 3 months of predialysis care and who started dialysis in the first year after the intervention. The primary efficacy outcome was the proportion of patients who initiated dialysis early (at eGFR >10.5 ml/min per 1.73 m2). The secondary outcome was the proportion of patients who initiated in the acute inpatient setting. RESULTS: The analysis included 3424 patients initiating dialysis in the 1-year follow-up period. Of these, 509 of 1592 (32.0%) in the intervention arm and 605 of 1832 (33.0%) in the control arm started dialysis early. There was no difference in the proportion of individuals initiating dialysis early or in the proportion of individuals initiating dialysis as an acute inpatient. CONCLUSIONS: A multifaceted knowledge translation intervention failed to reduce the proportion of early dialysis starts in patients with CKD followed in multidisciplinary clinics. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: ClinicalTrials.gov, NCT02183987. Available at: https://clinicaltrials.gov/ct2/show/NCT02183987.
Authors: Noah Ivers; Gro Jamtvedt; Signe Flottorp; Jane M Young; Jan Odgaard-Jensen; Simon D French; Mary Ann O'Brien; Marit Johansen; Jeremy Grimshaw; Andrew D Oxman Journal: Cochrane Database Syst Rev Date: 2012-06-13
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Authors: Elaine M T Chau; Braden J Manns; Amit X Garg; Manish M Sood; S Joseph Kim; David Naimark; Gihad E Nesrallah; Steven D Soroka; Monica Beaulieu; Stephanie Dixon; Ahsan Alam; Navdeep Tangri Journal: Can J Kidney Health Dis Date: 2016-09-14
Authors: Braden J Manns; Amit X Garg; Manish M Sood; Thomas Ferguson; S Joseph Kim; David Naimark; Gihad E Nesrallah; Steven D Soroka; Monica Beaulieu; Stephanie N Dixon; Ahsan Alam; Selina Allu; Navdeep Tangri Journal: Clin J Am Soc Nephrol Date: 2022-03-21 Impact factor: 8.237
Authors: Edouard L Fu; Marie Evans; Juan-Jesus Carrero; Hein Putter; Catherine M Clase; Fergus J Caskey; Maciej Szymczak; Claudia Torino; Nicholas C Chesnaye; Kitty J Jager; Christoph Wanner; Friedo W Dekker; Merel van Diepen Journal: BMJ Date: 2021-11-29