Matching CKD Education to Patient Readiness for Home Dialysis, With Christopher Chan, MD

An automated digital counseling program did not increase overall uptake of home kidney replacement therapy (KRT) in patients with chronic kidney disease (CKD), but patients who were motivationally ready at baseline were substantially more likely to initiate home KRT with the intervention, according to the ODYSSEE-Kidney Health trial.¹

Christopher Chan, MD, of University Health Network in Toronto, presented the findings at ASN Kidney Week 2026 in Denver, Colorado.

“We need to know our patients’ preference, we need to know our patients’ goals, and we also need to match the education towards their goals and preferences,” Chan told HCPLive.

Task force guidelines advocate informed decision-making about home-based KRT, including home peritoneal dialysis, home hemodialysis, and preemptive kidney transplant evaluation.¹ ODYSSEE is a digital cognitive behavioral therapy platform previously studied in hypertension and heart failure, Chan explained, designed to support education, self-efficacy, and patient activation.

Did Digital Counseling Increase Home Kidney Replacement Therapy Uptake?

The 2-arm, single-blind randomized controlled trial assigned 158 patients with CKD in a 1:1 ratio to ODYSSEE plus usual care or usual care alone. Eligible patients had a 2-year kidney failure risk above 10% using the 4-variable kidney failure risk equation. The primary outcome was a composite of home peritoneal dialysis, home hemodialysis, or evaluation for kidney transplant, monitored for a median of 12 months.^1,2

Participants were 70% male, with a mean age of 62 years and a mean 2-year kidney failure risk of 45%. At baseline, 16% reported being motivationally ready to act, measured with a validated readiness score.¹

Overall, 32 patients initiated home KRT, and incidence did not differ by randomized group (odds ratio [OR], 1.5; 95% CI, 0.7–3.2). However, a significant interaction emerged between randomized group and baseline readiness (OR, 16.6; 95% CI, 1.7–157.2).¹

Results showed the estimated probability of initiating home KRT was 0.75 among ready patients receiving ODYSSEE, compared with 0.33 among ready patients receiving usual care. In a Cox proportional hazards model, ODYSSEE was associated with a shorter time to home KRT among patients motivationally ready at baseline.¹

What Role Does Patient Readiness Play in Home Dialysis Decisions?

In a post hoc Bayesian analysis, ODYSSEE patients with baseline readiness had higher odds of initiating home KRT (OR, 4.71; 95% credible interval, 1.65–13.37), with a 99.8% posterior probability of benefit. The analysis estimated an 89% posterior probability baseline readiness positively modified the effect of ODYSSEE.¹

The investigators acknowledged the trial was underpowered to evaluate its primary outcome.¹ They concluded patient motivation is prospectively associated with initiation of home KRT or transplant evaluation, raising the challenge of building motivation-enhancing procedures into digital counseling.

Chan said the findings challenge the common view of CKD education as a single class or session. Effective education requires time to build a relationship and allow patients the mental space to change, whether delivered digitally or face to face, he explained.

He emphasized digital tools should supplement rather than replace in-person care, noting time away from the clinic far exceeds face-to-face encounters. “We need our clinical encounters and also additional supplemental form of education,” Chan said.

Looking ahead, Chan described developing additional digital adjuncts and education series to augment existing clinical services, including platforms designed for patients living with multiple chronic conditions.

References

1. Chan CT, Nolan R. The ODYSSEE-Kidney Health trial for home kidney replacement therapy (KRT). Poster presented at: ASN Kidney Week 2026; October 21-25, 2026; Denver, CO. doi:10.1681/ASN.2026v6z6x0b9

2. ODYSSEE-Kidney Health trial. ClinicalTrials.gov identifier: NCT06274710. Accessed October 24, 2026. https://clinicaltrials.gov/study/NCT06274710