Patient Navigation: Addressing Social Challenges in Dialysis Patients

Am J Kidney Dis. 2020 Jul;76(1):121-129. doi: 10.1053/j.ajkd.2019.06.007. Epub 2019 Sep 9.


Members of racial and ethnic minority groups make up nearly 50% of US patients with end-stage kidney disease and face a disproportionate burden of socioeconomic challenges (ie, low income, job insecurity, low educational attainment, housing instability, and communication challenges) compared with non-Hispanic whites. Patients with end-stage kidney disease who face social challenges often have poor patient-centered and clinical outcomes. These challenges may have a negative impact on quality-of-care performance measures for dialysis facilities caring for primarily minority and low-income patients. One path toward improving outcomes for this group is to develop culturally tailored interventions that provide individualized support, potentially improving patient-centered, clinical, and health system outcomes by addressing social challenges. One such approach is using community-based culturally and linguistically concordant patient navigators, who can serve as a bridge between the patient and the health care system. Evidence points to the effectiveness of patient navigators in the provision of cancer care and, to a lesser extent, caring for people with chronic kidney disease and those who have undergone kidney transplantation. However, little is known about the effectiveness of patient navigators in the care of patients with kidney failure receiving dialysis, who experience a number of remediable social challenges.

Keywords: End-stage kidney disease (ESKD); cultural sensitivity; culturally concordant care; dialysis; dialysis facility; disparities in care; health literacy; linguistic barriers; patient-centered care; peer support; racial/ethnic minorities; systemic bias; transplant access; transplant waitlisting; underserved communities.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Clinical Trials as Topic / economics
  • Clinical Trials as Topic / methods
  • Healthcare Disparities* / economics
  • Humans
  • Kidney Failure, Chronic / economics
  • Kidney Failure, Chronic / therapy*
  • Patient Navigation / economics
  • Patient Navigation / methods*
  • Renal Dialysis / economics
  • Renal Dialysis / methods*
  • Socioeconomic Factors*