RPD115 - Integrated kidney palliative care (KPC) versus usual nephrology care:): A pilot randomized controlled trial (RCT)

Key Message : 37 million Americans have chronic kidney disease (CKD) and suffer from multiple symptoms. We conducted a pilot randomized controlled trial (RCT) testing integrated kidney palliative care (KPC) versus usual nephrology care at safety net urban hospital. Our trial was feasible, setting the foundation for larger studies.

Abstract:

Background: Chronic Kidney Disease (CKD) is a serious illness that causes a substantial symptom burden and disproportionately impacts minoritized populations. Despite the palliative care needs in CKD, there are no RCTs testing its efficacy, a gap that leads to preventable suffering.

Objectives: To test the feasibility of a pilot RCT of integrated KPC versus usual care at a safety net hospital.

Methods: We randomized Spanish and English speakers ≥ 18 years old, with CKD stage IV, V, or on dialysis to usual CKD care, or to usual care and monthly ambulatory KPC visits for six months. Target sample size was for 60. The primary outcome was feasibility of recruitment, retention, and data collection. Exploratory outcomes were change in symptom burden, measured by the Integrated Palliative Outcome Scale (IPOS)-Renal, and analyzed using linear mixed-effects models adjusted for baseline score, dialysis status, age, sex, ethnicity, and race.

Results: 84 people (56%) provided consent, 75 (89%) were randomized, and 57 (76%) completed the trial (Figure 1, Table 1). 33% identified as Black, 56% as Hispanic, and 39% were Spanish speaking. 51% were on Medicaid, while 13% were uninsured. In fully adjusted models, at six months, the intervention group had a 3.1 point (95% CI: -10.2 to 2.1) lower symptom burden than the control group, though the estimate was imprecise given the pilot sample size.

Conclusions: We successfully conducted a KPC pilot RCT among a diverse population, demonstrating the feasibility of our intervention and trial. Full scale efficacy trials are warranted to test the potential of KPC to improve quality of life in a growing, underserved population.

References: none