Study Spotlight: Testing an intervention to enhance kidney transplant access – The EnAKT LKD Trial

The CDTRP is excited to highlight the important EnAKT LKD Trial, led by researchers and CDTRP members, Dr. Amit Garg and Dr. Kyla Naylor. This pragmatic cluster-randomized trial aims to improve patient access to kidney transplantation and living kidney donation. The Transplant Ambassador Program also plays a crucial role in supporting patient partners into this initiative.

Patients with advanced CKD have the best chance for a longer and healthier life if they receive a kidney transplant. A transplant also costs the healthcare system less- for every 100 kidney transplants, the healthcare system saves $20 million over five years, primarily from averted dialysis costs. However, due to several barriers, many eligible patients today will never receive a kidney transplant.

The EnAKT LKD Trial

To address this problem, a pragmatic cluster-randomized trial, the Effect of a Multi-Component Intervention to Improve Patient Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD) Trial, was designed and conducted by a broad group of stakeholders to determine if CKD program-wide use of a multicomponent intervention could help eligible patients complete key steps towards receiving a kidney transplant.

The trial included 20,375 patients who received care in Ontario’s 26 CKD programs. The trial period which began in November 2017 was 4.2 years. Unfortunately, the arrival of the COVID-19 pandemic negatively affected intervention delivery, as CKD programs faced staffing challenges and shifting priorities for at least a year.

Acknowledging the complications brought by the pandemic, the trial team was unable to show the intervention increased access to kidney transplantation and living kidney donation, despite evidence of intervention uptake at the participating centres.

  • “While we were unable to show this intervention increased access to kidney transplantation and living kidney donation, we are not giving up. We and others are deeply committed to addressing this complex and important problem. After much introspection, several aspects of our approach still seem sensible, such as the tracking of key steps towards transplant. We are currently completing a process evaluation to optimize our future approach.”

    Dr. Amit Garg, Nephrologist and Professor of Medicine, Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry.

Study outcomes

While the findings of the trial were not what the team had hoped for, the intervention did result in several beneficial outcomes and exhibited important strengths that could be used in future trials:

  • The trial emphasized the importance of CKD programs and transplant centres participating in a learning healthcare system. In other words, a culture shift where centre staff are committed to robust assessments of what they do.

  • The intervention was designed and implemented by diverse stakeholders, including administrators, healthcare staff, patients and nephrologists using new educational materials.

  • The extent of patient-partner involvement in the trial could pave the way for how we think about patient engagement in future trials. Patient partners played an integral role throughout the trial, including developing the research question, designing the intervention, and developing and leading a key component of the intervention, the Transplant Ambassador Program.

It is challenging to improve patient access to kidney transplantation in busy healthcare environments despite the urgent need for effective solutions.