ASN 2021: Highlights from Days 3 & 4 of the Annual Meeting

Catch up on some of the latest updates to come from the third and fourth days of the 2021 ASN Annual Meeting.

Words Matter: Standardizing CKD Nomenclature to Improve Patient Engagement & Communication

Although chronic kidney disease (CKD) nomenclature is designed to help support communication among clinicians, billing, and clinical documentation, it can be very misleading and confusing for patients. That’s why the “Words Matter: Standardizing CKD Nomenclature to Improve Patient Engagement and Communication” session explored patient perspectives, strategies for improving patient education, and more.

Here’s a quick recap of the presentations featured in this session.

Make It Plain: The Patient Perspective on CKD Terminology

Up first was patient advocate Ms. Glenda Roberts from the Kidney Research Institute & Center for Dialysis Innovation at the University of Washington.

As Ms. Roberts noted, there’s often a discrepancy between what patients want to know and what their clinician prioritizes. For instance, patients will ask questions regarding what they have, what will happen, what they can do, and what it means for their family, while clinicians tend to focus on performing diagnostic tests, conducting physical exams, working within time constraints, and prescribing treatment.

Since effective communication is critical for improving kidney care, Ms. Roberts provided the following keys to physician-patient collaboration:

• Show 30 seconds of empathy: Asking simple questions like “How are you feeling today?” and statements like “This might sting, but it won’t last long” will show patients that you care.
• Gain trust: Showing empathy, however, does not automatically mean patients will trust you. Trust is built when you do what you say you’re going to do, so if you say you’re going to follow up with results within a certain timeframe, be sure to do so.
• Listen: Encourage patients to ask questions and create a safe space for them to talk.
• Simplify: Use terms, analogies, and graphics patients are familiar with.
• Set expectations: Talk honestly and frankly with patients about what they’re likely to experience.
• Utilize patient-friendly glossaries: Glossaries and other resources are available at AAKP.org and kidney.org.

To conclude, Ms. Roberts encouraged attending nephrologists to activate the transformative power of collaboration to strengthen the healthcare system through meaningful relationships with patients.

A New Frontier: KDIGO Recommendations for Nomenclature for Kidney Function & Diseases

Dr. Andrew Levey from Tufts Medical Center was up next to discuss the importance of uniform nomenclature for CKD.

According to Dr. Levey, this standardization can help patients facilitate conversations with their healthcare provider as it takes into account patient preferences, needs, and values while also minimizing language ambiguity. And as for clinicians, uniform nomenclature can help reduce confusion and errors in clinical practice along with promoting consistency in research design, execution, and communication.

To ensure both patients and providers have the chance to fully reap these benefits, the 2019 Kidney Disease: Improving Global Outcomes (KDIGO)Consensus Conference convened so that nomenclature could be revised. Some of the strengths of the glossary created from this conference include:

• It’s based on KDIGO definitions, classifications, and nomenclature
• It’s based on a systemic process incorporating articulations of rationale and goals, patient and attendee surveys, and an attendee consensus

However, Dr. Levey noted that there are some limitations. For instance, the glossary is restricted to English so nuances may be difficult to translate, and it’s not comprehensive since several topics were out of scope. And while nomenclature standardization is a necessary step, it’s far from the only step that can help improve physician-patient communication, which led to the third presentation in this session.

Tools for the Patient Engagement Toolbox: Improving Health Literacy & Patient Education

The third presentation was given by Dr. Kerri Cavanaugh from the Vanderbilt University Medical Center. Dr. Cavanaugh began by defining personal health literacy as the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.

With that definition in mind, she then discussed how nephrologists can improve patients’ health literacy through the lens of four of the six objectives outlined in the Healthy People 2030 initiative:

1. Decrease the proportion of adults who report poor communication with their healthcare provider: It can be difficult to ensure that communication is consistent and effective, but patient education resources like brochures, graphics, and videos can help.
2. Increase the proportion of adults whose healthcare provider checked their understanding of what was discussed: The teach-back method can be effective. This involves asking the patient to say in their own words the three main takeaways from the conversation.
3. Increase the proportion of adults whose healthcare provider involved them in decisions as much as they wanted: Several tools like decision aids and risk calculators can help those patients who wish to be more involved in their treatment decisions, but it’s important to note that few decisions aids have been studied in trials to assess their impact on decisional, knowledge, and health outcomes.
4. Increase the proportion of people who say their online medical record is easy to understand: Educate and encourage patients to access their online portal so that the direction and communication surrounding online medical records can be improved.

According to Dr. Cavanaugh, these strategies can all improve communication in kidney disease care, which can in turn help promote health outcomes.

The three presentations included in this session all focused on a different aspect of a larger issue in kidney disease care, but by bringing them together, the importance of effective and clear communication with patients was brought to the forefront.

Telenephrology (TN) vs. Face-to-Face (F2F) Visits: A Comparison of Inpatient Nephrology Outcomes and Provider Perspectives

Telenephrology (TN) is an emerging service designed to help nephrologists reach patients from around the world, but the clinical outcomes, patient, and provider perspectives on inpatient synchronous telenephrology care haven’t really been studied.

A recent retrospective study compared outcomes in patients who’ve received inpatient synchronous TN plus face-to-face (F2F) compared to F2F alone at two Mayo Clinic Health System (MCHS) community hospitals.

850 hospitalized adults who had nephology consults between March 1, 2020, and February 28, 2021 were arranged into several diagnoses groups. Logistic regression was used to assess 30-day mortality, readmissions, and hospital transfers, and penalized regression was used in rare cases.

Of the patients included, the mean age was 69 years old, 59% were male, and 93% were white. Based on the data, cases were more likely to receive dialysis after a TN consult, and both non-nephrology providers and tele-nephrologists reported that some of the most common reasons for consults included acute kidney injury, end-stage renal disease, electrolytes, or acidosis.

The study found that 82% of tele-nephrologists often preferred video consults to phone calls for communication, and more than half of tele=nephrologists, about 64%, spent less time on TN compared to F2F consults. And on top of tele-nephrologists, 48% of non-nephrology hospital providers were very satisfied and 29% were satisfied with the response time of TN. 67% felt that TN was as safe as F2F and 76% believes that telenephrology gave them enough information to make patient care decisions.

Based on the study, researchers found that outcomes for in-hospital nephrology consults were similar between telenephrology plus face-to-face and face-to-face alone. Both tele-nephrologists and non-nephrology hospital providers had positive opinions for telenephrology, and believe that it’s a safe option to continue using.

Disparities in Kidney Care: Where Care Needs to Be Equal

Disparities in kidney care are widespread and continue to gain attention, and with new efforts to promote home modalities for dialysis, have care inequalities impacted hemodialysis? A recent study analyzed the key care difference that existed between home hemodialysis (HHD) and in-center hemodialysis (ICHD) patients between 2017 and 2020.

To collect this data, 1, 021 nephrologists submitted de-identified clinical and non-clinical demographics information for 4, 062 patients from the time of their referral to their most recent visit using a HIPAA-compliant, online chart review tool. This data was then merged with the physician demographic profile and analyzed in SPSS.

Based on the data collected, nephrologists’ patient load currently consists of 5 HHD patients 96 ICH patients, and on average, they initiate one new HHD patient and 17 new HCHD patients each year. And when comparing HHD and ICHD patients, the data has shown distinctive demographic differences.

HHD patients tend to be Caucasian and from higher education and socioeconomic levels: 52% are Caucasian and 25% are African American, 37% have some college and 14% have an advanced degree, and 67% are middle or upper class. However, ICHC patients are more diverse, have lower socioeconomic levels, and have less education: 40% are Caucasian and 40% are African American, 24% have some college and 5% have an advanced degree, and 44% are lower or lower-middle class.

On top of that, 70% of patients on home modalities were followed prior to dialysis, but only 48% of patients on ICHD were followed pre-dialysis, and HHD patients were 25% more likely to be on the transplant list compared to ICHD patients.

Disparities in care continue to exist between HHD patients and ICHD patients, and as kidney care continues to evolve, nephrologists will need to account for these differences in their treatment paradigms to ensure equal access to care across the board.