Golestaneh Ladan, Kim Ryung S, Roach Christopher, Norris Keith C, Fox Aaron D, Melamed Michal L, Cavanaugh Kerri L
Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut.
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
J Am Soc Nephrol. 2025 Oct 1;36(10):1998-2007. doi: 10.1681/ASN.0000000709. Epub 2025 Apr 15.
Peer mentorship did not reduce hospitalizations and emergency department visits in patients receiving hemodialysis overall but was effective in as-treated analysis. Peer mentorship may have improved dialysis knowledge, self-assessment of health, and possibly depressive symptoms. There was potential benefit from peer mentorship among self-identified Black patients and among those enrolled in Bronx, New York.
Patients receiving maintenance hemodialysis are hospitalized frequently, leading to disproportionate cost of care and contributing to high morbidity and mortality.
To test the effectiveness of peer mentorship to reduce hospitalization rates among patients receiving hemodialysis, we performed a multicenter, pragmatic, randomized, controlled trial. Two hundred patient participants receiving hemodialysis at high risk for hospitalization were enrolled, 140 in Bronx, New York, and 60 in Nashville, Tennessee. Of these, 101 were randomized to the peer mentor intervention, and 99 were randomized to usual care. The intervention consisted of trained mentors, patients receiving hemodialysis, placing weekly telephone calls to their assigned patient participant mentees over a 3-month period. During telephone calls, mentors listened, provided emotional and informational support, and promoted self-management. During the intervention period and up to 15 months later, patient participants were observed for incidence of the primary outcome: monthly counts of unplanned hospitalizations and emergency department visits.
The mean age of all patient participants was 54 (SD 13) years, 100 (50%) were female, 110 (57%) were Black, and 70 (39%) were Hispanic. The adjusted incidence rate ratio (aIRR) of primary outcome was not different between intervention versus usual care in intention-to-treat analysis (aIRR, 0.85; 95% confidence interval, 0.64 to 1.15). Prespecified as-treated analyses, with as treated defined by >20 minutes of telephone contact between mentor/mentee pairs, suggested effectiveness of peer mentoring (aIRR, 0.60; 95% confidence interval, 0.47 to 0.76), and exploratory analyses demonstrated differences in effectiveness by site and self-identified race of mentees.
Peer mentorship did not significantly reduce the rate of hospitalization or emergency department visits overall, but there may have been effectiveness among the following subgroups: those enrolled in Bronx, New York, and those who self-identified as Black.
: ClinicalTrials.gov 2017-8531; NCT03595748.
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总体而言，同伴指导并未降低接受血液透析患者的住院率和急诊就诊次数，但在实际治疗分析中是有效的。同伴指导可能改善了透析知识、健康自我评估，也可能改善了抑郁症状。在自我认定为黑人的患者以及纽约布朗克斯区登记入组的患者中，同伴指导可能有益。
接受维持性血液透析的患者经常住院，导致护理成本过高，并导致高发病率和高死亡率。
为了测试同伴指导对降低接受血液透析患者住院率的有效性，我们进行了一项多中心、实用、随机、对照试验。招募了200名有高住院风险的接受血液透析的患者参与者，其中140名在纽约布朗克斯区，60名在田纳西州纳什维尔。其中，101名被随机分配到同伴指导干预组，99名被随机分配到常规护理组。干预措施包括由经过培训的指导者，即接受血液透析的患者，在3个月内每周给他们指定的患者参与者 mentees 打电话。在电话中，指导者倾听、提供情感和信息支持，并促进自我管理。在干预期间及之后长达15个月的时间里，观察患者参与者的主要结局发生率：每月非计划住院和急诊就诊次数。
所有患者参与者的平均年龄为54（标准差13）岁，100名（50%）为女性，110名（57%）为黑人，70名（39%）为西班牙裔。在意向性分析中，干预组与常规护理组的主要结局调整发病率比（aIRR）无差异（aIRR，0.85；95%置信区间，0.64至1.15）。预先设定的实际治疗分析中，将指导者/受指导者对之间电话联系>20分钟定义为实际治疗，提示同伴指导有效（aIRR，0.60；95%置信区间，0.47至0.76），探索性分析表明，根据受指导者的地点和自我认定的种族，有效性存在差异。
同伴指导总体上并未显著降低住院率或急诊就诊率，但在以下亚组中可能有效：纽约布朗克斯区登记入组的患者以及自我认定为黑人的患者。
ClinicalTrials.gov 2017 - 8531；NCT03595748。
本文包含一个播客，网址为https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/JASN/2025_07_10_ASN0000000709.mp3
