Patients with advanced chronic kidney disease (CKD) have the best chance for a longer and healthier life if they receive a kidney transplant. However, due to several barriers, many eligible patients today will never receive a kidney transplant.


The EnAKT LKD Trial was conducted to determine if CKD program-wide use of a multicomponent intervention could help eligible patients complete key steps towards receiving a kidney transplant. The trial included 20,375 patients who received care in Ontario’s 26 CKD programs over more than four years. Unfortunately, the arrival of the COVID-19 pandemic negatively affected intervention delivery, as CKD programs faced shifting priorities.


Acknowledging the complications brought by the pandemic, the trial team was unable to show the intervention increased access to kidney transplantation and living kidney donation, despite evidence of intervention uptake at the participating centres.


The intervention exhibited important strengths that could be used in future trials:

    • The trial resulted in a culture shift across participating centres where staff are committed to robust assessments of quality improvement initiatives.
    • The intervention was designed and implemented by diverse stakeholders, including administrators, healthcare staff, patients and nephrologists using new educational materials.
    • The extent of patient-partner involvement in the trial could pave the way for how we think about patient engagement in future trials. Patient partners played an integral role throughout the trial, including leading a key component of the intervention, the Transplant Ambassador Program.

While the team was unable to show this intervention increased access to kidney transplantation and living kidney donation, they are not giving up. They are deeply committed to addressing this complex and important problem.