A stepped wedge cluster randomized trial of graphical surveillance of kidney function data to reduce late presentation for kidney replacement therapy.

Journal article

Gallagher, H., Methven, S., Casula, A., Rayner, H., Lenguerrand, E., Thomas, N., Dawnay, A., Kennedy, D., Woolnough, L., Nation, M. and Caskey, F.J. (2024). A stepped wedge cluster randomized trial of graphical surveillance of kidney function data to reduce late presentation for kidney replacement therapy. Kidney International. https://doi.org/10.1016/j.kint.2024.04.020
AuthorsGallagher, H., Methven, S., Casula, A., Rayner, H., Lenguerrand, E., Thomas, N., Dawnay, A., Kennedy, D., Woolnough, L., Nation, M. and Caskey, F.J.
AbstractLate presentation for kidney replacement therapy (KRT) is an important cause of avoidable morbidity and mortality. Here, we evaluated the effect of a complex intervention of graphical estimated glomerular filtration rate (eGFR) surveillance across 15% of the United Kingdom population on the rate of late presentation using data routinely collected by the United Kingdom Renal Registry. A stepped wedge cluster randomized trial was established across 19 sites with eGFR graphs generated from all routine blood tests (community and hospital) across the population served by each site. Graphs were reviewed by trained laboratory or clinical staff and high-risk graphs reported to family doctors. Due to delays outside the control of clinicians and researchers few laboratories activated the intervention in their randomly assigned time period, so the trial was converted to a quasi-experimental design. We studied 6,100 kidney failure events at 20 laboratories served by 17 main kidney units. A total of 63,981 graphs were sent out. After adjustment for calendar time there was no significant reduction in the rate of presentation during the intervention period. Therefore, implementation of eGFR graph surveillance did not reduce the rate of late presentation for KRT after adjustment for secular trends. Thus, graphical surveillance is an intervention aimed at reducing late presentation, but more evidence is required before adoption of this strategy can be recommended. [Abstract copyright: Copyright © 2024. Published by Elsevier Inc.]
Keywordschronic renal insufficiency; randomised controlled trial; quality improvement; Renal replacement therapy
Year2024
JournalKidney International
PublisherElsevier
ISSN1523-1755
Digital Object Identifier (DOI)https://doi.org/10.1016/j.kint.2024.04.020
Web address (URL)https://www.sciencedirect.com/science/article/abs/pii/S0085253824003399?via%3Dihub
Publication dates
Online24 May 2024
Publication process dates
Accepted30 Apr 2024
Deposited24 Jun 2024
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