Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

What is the comparative effectiveness of patient education interventions to enhance self-care and self-management on chronic kidney disease (CKD) progression

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Various educational programs related to CKD to enhance self-care and self-management

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Adults with pre-dialysis CKD

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

The elderly, obese, and minority groups (including Hispanics and African-Americans)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Estimated glomerular filtration rate (eGFR), serum creatinine, time to dialysis, albuminuria, blood pressure, survival

Describe any health-related risks, side effects, or harms that you are concerned about.

None expected

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cardiovascular disease, including stroke and hypertension
• Diabetes mellitus
• Obesity

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

CKD is a significant public health problem affecting more than 30 million adults in the United States adults 1. Individuals with CKD are at increased risk for hospitalization, cardiovascular disease, end-stage renal disease (ESRD), and death.1-3The associated morbidity often leads to a decreased quality of life.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

This topic was identified in our AHRQ/EHC sponsored topic identification project. Among a large number of CKD topics, a group of stakeholders ranked this as a high priority topic.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

It would seem beneficial to educate patients about their disease and the possible ways to improve outcomes. Successful educational interventions for individuals with chronic diseases typically incorporate informational components to improve knowledge, along with a variety of psychological methods to change behavior and empower individuals.4 Such interventions have been shown to produce clinically important benefits for diabetic and hypertensive individuals as well as for individuals with other chronic diseases such as cardiovascular disease, lung disease, and arthritis. The evidence regarding the use of educational interventions in pre-dialysis kidney disease has been limited, but there are several recent trials addressing this question.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Convincing evidence on effective weight interventions will potentially change guidelines and practice.

Describe the timeframe in which an answer to your question is needed.

No particular timeframe, rather this is an ongoing and increasing problem for society.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

CKD has a higher prevalence among African Americans, Hispanics, and elderly people, disparity populations with poor access and underutilization, lower economic and educational status, and inner city and some rural populations.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Convincing evidence on effective weight interventions will potentially change guidelines and practice.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program