Optimal Education: Paving the Way for True Optimal Start Dialysis.

The comprehensive kidney care contracting program defines Optimal End Stage Renal Disease Starts as new patients with end-stage kidney disease who receive a preemptive kidney transplant, home dialysis, or initiating in-center hemodialysis using an arteriovenous access. These optimal starts are not possible without optimal patient education. Because policy changes make treatment options become available regardless of diagnosis (acute or chronic kidney injury) and setting, education must similarly evolve to be both site-independent and diagnosis-independent. In this piece, we explore gaps in the delivery of kidney failure modality education across the outpatient nephrology clinics, and dialysis units, and inpatient setting. We highlight both national and international models in each that have proven successful, the important role of both urgent-start peritoneal dialysis and transitional care units, and provide a roadmap for the successful implementation of an inpatient kidney failure educational program to help combat the reality of the high incidence of in-center hemodialysis among crash-start patients.