Implementing Patient Education in the CKD Clinic

  • Jane S. Davis
    Address correspondence to Jane S. Davis, 3605 Oakdale Road, Birmingham, AL.
    Department of Nephrology, University of Alabama at Birmingham, Birmingham, AL; and The National Kidney Foundation/Council of Advanced Practitioners, Metropolitan Nephrology, Alexandria, VA
    Search for articles by this author
  • Kim Zuber
    Department of Nephrology, University of Alabama at Birmingham, Birmingham, AL; and The National Kidney Foundation/Council of Advanced Practitioners, Metropolitan Nephrology, Alexandria, VA
    Search for articles by this author
      The passage of the Medicare Improvements for Patients and Providers Act (MIPPA) encouraged education for Stage 4 CKD patients by reimbursing qualified providers for formal instruction. This marked the first time Medicare reimbursed for kidney disease education. Although the law lays out specific requirements, it leaves much of the structure and content of the instruction up to the providers. The CKD clinic staffed by advanced practitioners (physician assistants, nurse practitioners, and/or clinical nurse specialists) provides a natural fit for patient education. Educated patients choose home modalities more frequently; more often start dialysis with a permanent vascular access; and generally score higher on tests measuring mood, mobility, and anxiety. However, sufficient research into the effects of CKD patient education is lacking.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Advances in Chronic Kidney Disease
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Zuber K.
        • Davis J.
        Stories from the trenches.
        Nephrol News Issues. 2012; 6: 20-21
        • Jo Mason
        • Kamlesh K.
        • Stone M.
        • Farooqi A.
        • Carr S.
        Educational interventions in kidney disease care: a systematic review of randomized trials.
        Am J Kidney Dis. 2008; 51: 933-951
        • Golper T.
        Patient education: can it maximize the success of therapy?.
        Nephrol Dial Transplant. 2001; 16: 20-24
        • Korniewick D.M.
        • O’ Brien M.E.
        Evaluation of a hemodialysis patient education and support program.
        ANNA J. 1994; 21: 33-38
        • Klang B.
        • Björvell H.
        • Berglund J.
        • Sundsted C.
        • Clyne N.
        Predialysis education: effects on functioning and well-being in uraemic patients.
        J Adv Nurs. 1998; 28: 36-44
        • Devins G.M.
        • Mendelssohn D.C.
        • Barre P.E.
        • Binik Y.M.
        Predialysis psychoeducational intervention and coping styles influence time to dialysis in chronic kidney disease.
        Am J Kidney Dis. 2003; 42: 693-703
        • Levins A.
        • Djurdjev O.
        • Beaulieu M.
        • Lee E.
        Variability and risk factors for kidney disease progression and death following attainment of stage 4 CKD in referred cohort.
        Am J Kidney Dis. 2008; 52: 661-671
        • Young H.N.
        • Chan M.R.
        • Yevzlin A.S.
        • Becker B.N.
        The rationale, implementation and effect of the Medicare CKD educational benefit.
        Am J Kidney Dis. 2011; 57: 381-386
        • Bolton K.
        Renal Physicians Association clinical practice guideline: appropriate patient preparation for renal replacement therapy: guideline number 3.
        J Am Soc Nephrol. 2003; 14: 1406-1410
        • King K.
        • Whitten B.
        • Brown J.M.
        • Whitlock R.W.
        • Waterman A.D.
        The Missouri Kidney Program’s Patient Education Program: a 12-year retrospective analysis.
        Nephrol News Issues. 2008; 22: 44-54
        • U S Renal Data System
        USRDS 2012 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States.
        National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD2012
        • DePasquale N.
        • Ephraim P.
        • Ameling J.
        • et al.
        Selecting renal replacement therapies: what do African American and non-African American patients and their families think others should know? A mixed methods study.
        BMC Nephrol. 2013; 14: 9
        • Finklestein F.O.
        • Story K.
        • Firanek C.
        • et al.
        Perceived knowledge among patients cared for by nephrologists about chronic kidney disease and end-stage renal disease therapies.
        Kidney Int. 2008; 74: 1178-1184
        • Schall J.
        New Medicare law makes historic changes in the ESRD program.
        Renal Life. 2008;
      1. Fed Regist. 2009; 74: 2003
        • Zuber K.
        • Davis J.S.
        • Rizk D.V.
        Kidney disease education benefit one year after the Medicare Improvement of Patients and Providers Act: a survey of US nephrology practices.
        Am J Kidney Dis. 2012; 59: 892-894
        • Devraj R.
        • Gordon E.J.
        Health literacy and kidney disease: toward a new line of research.
        Am J Kidney Dis. 2009; 53: 884-889
      2. Glassman P. Health literacy. National Network of Libraries of Medicine. Available at: Accessed December 27, 2012.

        • Ottosen T.
        Promoting health literacy through easy-to-read materials.
        National Network of Libraries of Medicine, Birmingham, AL2011
        • Fadem S.Z.
        • Walker D.R.
        • Abbot G.
        • et al.
        Satisfaction with renal replacement therapy and education: the American Association of Kidney Patients Survey.
        Clin J Am Soc Nephrol. 2011; 6: 605-612
        • Cavanaugh K.
        • Wingard R.
        • Hakim R.
        • et al.
        Low health literacy associates with increased mortality in ESRD.
        J Am Soc Nephrol. 2010; 21: 1979-1985
      3. Health literacy facts. Network 8, Inc. 2011. 601-936-9260

        • Becker B.N.
        Focusing on health literacy might help us cross the quality chasm.
        Am J Kidney Dis. 2009; 53: 730-732