Table 2 TEACH-VET Comprehensive Pre-ESKD kidney disease Education (CPE) Protocol domains and Missions

• Location and Function of the Human Kidneys

• Overview of Kidneys in Human Health

o Excretory Functions of the Kidneys

o Non-excretory Functions of the Kidneys

▪ Importance in cardiovascular health

▪ Importance in bone health

▪ Importance in Anemia

• CKD and stages?

o Differentiate CKD from Acute kidney injury

• Understand Kidney Failure (ESKD)

o Common Symptoms of Kidney Failure

o Common Signs of Kidney Failure

• Options for the management of Kidney Failure?

o Kidney Transplantation

o Conservative Care

o Dialysis therapies

▪ Home-based Peritoneal Dialysis

▪ Home-based Hemodialysis

▪ Center-based Hemodialysis

• Lifestyle on Dialysis

• Frequently Asked Questions

• CPE should be available to all patients with stage 4 and 5 CKD, irrespective of their socio-demographic and comorbidity status, or perceived eligibility for home dialysis therapies

• For eligible patients, kidney transplantation is the best modality of renal replacement therapy

• It is important to know the cause of transplant ineligibility, and the possible corrective measures

• All dialysis modalities have equivalent medical outcomes

• Unless deemed medically/socially unsuitable by the provider, the choice of dialysis modality is a patient and caregiver’s decision and should be targeted as a shared decision-making process

• Avoid fear as an overbearing motivator for dialysis modality selection by ensuring the patients that the routine care should provide adequate support for any of the modalities chosen for most patients

• Decision for dialysis should be attempted early in the course of advanced CKD, if possible, by the end of the CPE session. If not feasible, the patient must plan to attend additional CPE sessions.

• All patient selections should be evaluated for confidence in dialysis decision making, with the options for patients with low confidence to attend follow up sessions