"Kidney Bucks": An Incentives Program for Pediatric Dialysis Patients

Background: Pediatric dialysis patients are at risk for a variety of metabolic derangements, including hyperkalemia, hyperphosphatemia, and fluid overload. Management of these problems includes patient education, dietary restrictions, and the use of phosphate-binding medications. Hypothesis: The purpose of the present research is to examine the efficacy of an incentives program, “Kidney Bucks”, which offers rewards in exchange for fluid control and normal lab values for phosphorus and potassium. Methods: The study was a retrospective investigation initiated in January 2015 at Cook Children’s Medical Center (CCMC). To be included in this study, patients had to be dialysis patients from July 2014 to June 2015, and had to be between the ages of 5 and 21 during this time. Longitudinal analyses were utilized to test whether the amounts of Kidney Bucks earned--overall and for each of the three components--differed before and after the intervention. For this purpose, the amount of Kidney Bucks that patients would have hypothetically earned preintervention in 2014 was computed and compared to the amount actually earned postintervention in 2015. Fourteen peritoneal dialysis patients and 13 hemodialysis patients met the inclusion criteria, totaling 27 patients. Results: Peritoneal dialysis (P=.01) patients earned more Kidney Bucks overall postintervention. Hemodialysis (P=.02), but not peritoneal dialysis, patients earned more Kidney Bucks for potassium postintervention, but neither group differed in phosphorus values. Lastly, peritoneal dialysis, but not hemodialysis, patients earned much more Kidney Bucks for fluid control post-intervention (P Conclusions: The study’s limitations include the relatively small sample size and the retrospective design. This study has important implications for practitioners who face the challenge of dietary adherence in pediatric populations and, despite its limitations, serves as a good foundation for future studies.