A recent cluster-randomized trial called EnAKT LKD aimed to improve access to kidney transplants for patients with kidney failure. The trial involved 10,000 eligible patients between the ages of 18-75 who entered each of the two trial arms for a 4.2-year period. Half of these patients were approaching a need for dialysis. The multicomponent intervention in the trial included administrative support, educational resources, patient support groups, and performance reports, all designed to address barriers preventing kidney transplantation and living donation.
However, the trial did not find a significant difference in the rate at which patients completed the four key steps towards receiving a kidney transplant between the intervention and usual-care groups. The researchers analyzed the primary outcome using a patient-level constrained multistate model, which accounts for the different steps in the transplant process. Although evidence of the intervention’s uptake was observed, the trial investigators are now working on a modified approach to address the issue of access to transplantation.
Increasing the number of living kidney donors was one of the aims of the trial, as this is seen as a way to meet the demand for kidney transplants. However, there are various barriers to living donation, such as healthcare system issues and the reluctance of people to come forward as donors. The trial aimed to address these barriers but did not achieve the desired outcomes. While all types of transplants were counted in the primary analysis, the trial also looked separately at living donor transplants as an additional outcome.
Overall, the EnAKT LKD trial sought to improve access to kidney transplants but did not find a significant difference in the completion of key steps towards transplantation. The findings highlight the complexity of the issue and the need for further research and interventions to address barriers and increase access to this life-saving procedure.
