Peer support for people starting dialysis without preparation – a non-randomised controlled feasibility trial

Background: People who present late to specialist renal services miss out on full preparation for dialysis and go on to experience a range of disadvantages including increased mortality and morbidity and reduced treatment options. Because people from black and other ethnic minorities are more likely to present late, these disadvantages drive health inequalities related to ethnicity. Support from peers with lived experience of kidney disease might ameliorate some of these disadvantages. This study aimed to assess the feasibility and investigate the effects of peer support for ‘late presenters’ with a view to informing the design of a randomised controlled trial. Methods The study design was a non-randomised pilot trial of four weeks of weekly peer support in addition to standard care for late presenters, using the six months prior to commencement of the intervention as a control comparison phase. All individuals starting maintenance renal replacement therapy (RRT) within 90 days of presentation to the unit were targeted for recruitment. Outcome measures included clinical data, patient reported outcomes, and patient activation. Results 21 consented to participate giving a recruitment rate of 75%. 100% of recipients of peer support felt it had been useful. 84% were happy with the amount of peer support received despite only 25% receiving the intervention exactly according to protocol. Analysis suggested no differences between intervention groups on clinical or patient reported outcome measures. Conclusions This novel study shows that peer support is a feasible intervention for people who start dialysis without preparation. It should be offered at more than one time-point and for flexible duration in order to optimise take up and efficiency. Although this is a feasibility study the results suggest no significant need for further study before widespread adoption of peer support as an intervention for late presenters due to high patient appetite and no evidence of safety concerns. Trial Registration ISRCTN63482335 19/04/2023 / IRAS ID: 204510 10/10/2016