Dialysis or kidney transplant? New tool may help patients make informed decisions

Ontario renal programs are taking advantage of a new digital tool to help dialysis patients better understand the potential survival benefits of a kidney transplant.

The Dialysis vs. Kidney Transplant – Estimated Survival in Ontario risk calculator can be used by doctors, social workers, nurses, and patient educators through the web or an iPhone app. The tool takes basic health and demographic information from patients and provides an easy-to-read visual estimate of the 3-year survival/mortality risk for dialysis versus living or deceased donor kidney transplantation. The goal is to help patients and families understand the potential difference in survival outcomes between treatment options in order to make more educated treatment decisions.

Researchers at London Health Sciences Centre rolled out the risk calculator in Ontario renal programs in spring 2018 as part of a Can-SOLVE CKD research project looking to improve access to kidney transplantation and living kidney donation. The tool is being used as part of a multi-component strategy developed by the researchers to improve access to kidney transplantation and living kidney donation. Thirteen of the 26 Ontario renal programs have been randomly selected to implement the strategy, while the other renal programs will serve as the routine care group. The routine care group will continue to support access to kidney transplantation and living kidney donation as they usually do for their patients. Renal care in Ontario is organized through 26 renal programs, that provide services to approximately 10,000 patients receiving dialysis and 15,000 patients with advanced kidney disease cared for in multi-care kidney clinics.

The initial response from clinic staff to the new tool has been very positive.

“I use the Dialysis vs. Kidney Transplant – Estimated Survival in Ontario risk calculator with patients during their initial transplant evaluation appointment. The risk calculator is very simple to use and the information is displayed in an easy to understand format. The majority of patients are genuinely surprised when I show them their survival if treated with a kidney transplant compared to dialysis. Patients seem to find this information more meaningful because we are using their own specific characteristics rather than generalizations that sound like ‘just a number’. I will definitely continue to use the risk calculator and I am working on integrating it into the transplant education pathway at our transplant centre.”

Dr. Seychelle Yohanna
Transplant Nephrologist, St. Joseph’s Healthcare, Hamilton

“I never fully appreciated the benefits of kidney transplantation for older patients aged 60 and 70 years until using the Dialysis vs. Kidney Transplant – Estimated Survival in Ontario risk calculator which visually displays survival estimates with a kidney transplant versus dialysis in an impactful manner.”

Hemodialysis nurse

The risk calculator was adapted from the iChoose Kidney tool originally developed at Atlanta’s Emory University. iChoose Kidney has been validated in the United States, and the Ontario researchers performed an external validation study to ensure the model was accurate across Ontario’s diverse dialysis population.

To validate the tool using Ontario data, the London-based team collaborated with researchers in Georgia. The validation study results were published recently in the Canadian Journal of Kidney Health and Disease and found the tool was able to adequately predict mortality in an Ontario cohort of end-stage kidney disease patients with only minor modifications.

The risk calculator is available on the web or as a mobile download. The app can be downloaded for free from the iTunes store or by scanning the code below.

Instructions for using the risk calculator can be viewed here. The tool is intended to help dialysis patients make an informed decision on whether to pursue kidney transplantation. It has not been validated in pre-dialysis patients.

Please note the following:

  • The risk calculator is not to be used by patients on their own time rather the tool should be used by doctors, social workers, nurses, and/or patient educators with chronic dialysis patients and their families to help dialysis patients make more educated treatment decisions.
  • This tool should not be used to identify patients who may not be good transplant candidates.
  • This tool should only be used with patients who are reasonable candidates for a kidney transplant.

For more information, please contact Kyla Naylor (kyla.naylor@lhsc.on.ca).

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