Cross-sectional Surveys: Impact of Kidney-CAP availability on health provider and patient decisions related to vascular access, dialysis modality and kidney transplantation

IntroductionCatastrophic bleeding can be fatal in patients on hemodialysis using Arteriovenous (AV) fistulas or grafts. Campaigns, such as the UK "Put a Lid On It" and the Australia "Stop the Bleed" have recommended use of bleeding cessation devices, but evidence for their use remains limited. Recent creation of the bleeding cessation device "Kidney-CAP" mandated further study. The objective of this study was to determine how the Kidney-CAP modified decisions related to vascular access, dialysis modality, and kidney transplantation. MethodsCross-sectional surveys were administered at a Canadian academic nephrology program, to health care providers (HCP) managing patients with chronic kidney disease (CKD), to patients on hemodialysis (CKD-HD), and to patients with CKD but not on dialysis (CKD-Clinic). Two tailed, one sample sign test was used to determine if the median response to Likert scale questions differed from "no effect" response, to a p-value of < 0.05. ResultsSurvey respondents included 18 HCP, 23 CKD-HD and 30 CKD-Clinic patients. Having a Kidney-CAP increased CKD-Clinic patients desire to undergo AVF or AVG creation (p=0.020). Having a Kidney-CAP had no impact on CKD-HD patients deside to undergo AVF creation, or to pursue hemodialysis at home, but increased desire to undergo kidney transplantation (p=0.031). Availability of the Kidney-CAP had no impact on HCP recommendations related to AVF creation or kidney transplantation, but increased HCP recommendations for home hemodialysis in ESKD patients (p=0.039 for each). ConclusionThis is the first study to assess the perceived benefit of a bleeding cessation device, with a focus on clinical decision making related to vascular access, kidney transplantation, and dialysis modality. The Kidney-CAP is associated with increased patient uptake of kidney transplantation and creation of AVF. Further study is required to delineate patient decisions within demographic subgroups such as previous kidney transplant, or anticoagulation status.