7. PROJECT SUMMARY/ ABSTRACT
Over 750,000 people in the US have kidney failure, and most are treated with hemodialysis. Despite evidence-
based guidelines recommending hemodialysis initiation via an arteriovenous (AV) vascular access (fistula or
graft), 80% of US patients start hemodialysis with a central venous catheter, resulting in significant morbidity,
mortality, and healthcare system expense. Additionally, there are stark racial disparities in the timely creation
of AV access. Black patients are 20% less likely than White patients to start hemodialysis with a fistula despite,
on average, being younger and having fewer comorbidities. Patients report delaying AV access surgery
because of fear, reluctance to start dialysis, and worries about disfigurement, needles, and pain, as well as
having an insufficient understanding of vascular access. To date, interventions aiming to increase uptake of the
evidence-based recommendation for pre-dialysis AV access creation have focused on systems rather than
patients, leaving unmet the well-documented educational and emotional needs of patients. Our central
hypothesis is that strengthening patient preparedness through tailored AV access education and support will
improve rates of AV access creation prior to hemodialysis initiation and reduce racial disparities. Applying well-
established frameworks, we will conduct a hybrid type 1 effectiveness-implementation study of a user-tested,
efficacious education package that provides vascular access health information and validates common patient
emotions, with and without augmentation through motivational interviewing (MI). Specifically, we will conduct a
3-arm, parallel group, randomized trial of 3 education strategies: focused vascular access education
(Education), MI-enhanced vascular access education (Education-Plus), and no focused vascular access
education (Usual Care) among patients with advanced CKD at two health systems to 1) compare the
effectiveness of Education, Education-Plus, and Usual Care for increasing the proportion of patients with pre-
dialysis AV access creation, and 2) identify factors influencing the implementation of the education strategies in
order to guide their equitable translation to the non-trial setting. We will evaluate the education strategies by
examining relevant elements of the RE-AIM framework: Reach, Effectiveness, and Implementation.
Importantly, we will determine whether and why these elements differ for Black and White patients. This
research will yield critical effectiveness data about patient-focused education strategies to improve vascular
access outcomes, and actionable information about implementation that will accelerate the equitable uptake of
our findings, address disparities in vascular access care, and inform the delivery of other education content to
patients with advanced CKD.
