Digital CKD counseling showed promise for patients ready to consider home treatment

An automated digital counseling program did not increase overall uptake of home kidney replacement therapy among people with chronic kidney disease, but patients who were already motivated to consider it were more likely to start treatment or pursue transplant evaluation. The findings suggest that when and how education is offered may matter as much as the information itself.

Christopher Chan, MD, of University Health Network in Toronto, presented results from the ODYSSEE-Kidney Health trial at ASN Kidney Week 2026 in Denver. The study tested whether a digital program added to usual care could help patients make informed decisions about home-based kidney treatment, including peritoneal dialysis, hemodialysis and kidney transplant evaluation.

Who appeared to benefit?

The randomized trial assigned 158 patients to digital counseling plus usual care or usual care alone. Participants had a kidney failure risk above 10% over two years; their average risk was 45%. Researchers followed the primary outcome—a combination of starting home dialysis or undergoing transplant evaluation—for a median of 12 months. Overall, 32 participants initiated home kidney replacement therapy, with no significant difference between the groups.

At the start of the trial, 16% of participants were classified as motivationally ready to act. Among those patients, the estimated probability of starting home treatment was 0.75 with digital counseling, compared with 0.33 with usual care. The researchers found an interaction between baseline readiness and treatment assignment, but the trial was underpowered to assess its primary outcome. The subgroup finding therefore needs cautious interpretation; the study does not establish that counseling will increase uptake for patients who are not yet ready.

Why Chan favors ongoing education

Chan said the results challenge the idea that chronic kidney disease education can be delivered as a single class or session. He said effective education takes time to build a relationship and give patients room to consider changes, and should reflect their goals and preferences.

Digital tools, he said, should supplement rather than replace in-person care. Chan described plans to develop additional digital education programs, including tools for people managing multiple chronic conditions. The trial did not establish which approaches best build readiness or how much counseling patients need; those questions remain open.

This report draws on information from hcplive.com.