Pilot Randomized Controlled Trial (RCT) of Integrated Kidney Palliative Care (KPC) and CKD Care vs. Usual CKD Care Alone in a Safety Net Hospital: A Feasibility Study

Background: RCTs show integrated palliative care improves symptoms compared with disease directed care, but no similar RCTs exist in CKD. We conducted a pilot RCT of integrated KPC and CKD care compared with usual CKD care at a safety net hospital. Methods: Spanish/English speakers ≥ 18 years, with CKD IV, V, or on dialysis were randomized to usual CKD care, or to CKD care and monthly KPC visits for six months. Target sample to complete the RCT was 60, with feasibility as the primary outcome. Other outcomes were change in symptoms at six months, measured by the Integrated Palliative Outcome Scale (IPOS)-Renal and analyzed with linear regression adjusted for baseline scores, dialysis status, time, age, sex, and race. Results: 84 people (56%) consented, 75 (89%) were randomized, and 57 (76%) completed the RCT (Fig. 1, Table 1). At six months, the KPC group had lower adjusted IPOS scores (lower burden) compared with usual care, but this did not reach statistical significance (β=1.26, p=0.637). Conclusion: We show feasibility of the first US efficacy pilot RCT of KPC and found a lower symptom burden in the KPC group compared with usual care. Full scale efficacy RCTs trsting KPC are warranted.. Funding: NIDDK SupportTable 1: Demographics of trial participantsFigure 1. Consort diagram of our pilot RCT comparing Kidney Palliative Care (KPC) + Chronic Kidney Disease (CKD) care to Usual CKD care.