Impact of an in-Hospital Patient Education Program on Choice of Renal Replacement Modality in Unplanned Dialysis Initiation

Schanz, Moritz; Ketteler, Markus; Heck, Michael; Dippon, Juergen; Alscher, Mark Dominik; Kimmel, Martin

doi:10.1159/000484531

Cited by 13 publications

(22 citation statements)

References 39 publications

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“…Eligible studies included incident chronic dialysis patients (n = 42) 2-4,6,8,9,13-48 and patients with CKD known to nephrology (n = 6). 5,49-53 Study designs included retrospective cohort studies (n = 27), 2,3,5,6,14-16,19-24,26,28,31-36,38,47…”

Section: Resultsmentioning

confidence: 99%

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Risk Factors for Unplanned Dialysis Initiation: A Systematic Review of the Literature

Hassan

Akbari

Brown

et al. 2019

Can J Kidney Health Dis

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Background:Unplanned dialysis initiation is common in patients with chronic kidney disease (CKD).Objective:To determine common definitions and patient risk factors for unplanned dialysis.Design:Systematic review.Setting:MEDLINE, EMBASE, and the Cochrane Library were searched from inception to February 2018.Patients:Studies that included incident chronic dialysis patients or patients with CKD that cited a definition or examined risk factors for unplanned dialysis were included.Measurements:Definitions and criteria for unplanned dialysis reported across studies. Patient characteristics associated with unplanned dialysis.Methods:Two reviewers independently extracted data using a standardized data abstraction form and assessed study quality using a modified New Castle Ottawa Scale.Results:From 2797 citations, 48 met eligibility criteria. Reported definitions for unplanned dialysis were variable. Most publications cited dialysis initiation under emergency conditions and/or with a central venous catheter. The association of patient characteristics with unplanned dialysis was reported in 26 studies, 18 were retrospective and 21 included incident dialysis patients. The most common risk factors in univariate analyses were (number of studies) increased age (n = 7), cause of kidney disease (n = 6), presence of cardiovascular disease (n = 7), lower serum hemoglobin (n = 9), lower serum albumin (n = 10), higher serum phosphate (n = 6), higher serum creatinine or lower estimated glomerular filtration rate (eGFR) at dialysis initiation (n = 7), late referral (n = 5), lack of dialysis education (n = 6), and lack of follow-up in a predialysis clinic prior to dialysis initiation (n = 5). A minority of studies performed multivariable analyses (n = 10); the most common risk factors were increased age (n = 4), increased comorbidity score (n = 3), late referral (n = 5), and lower eGFR at dialysis initiation (n = 3).Limitations:Comparison of results across studies was limited by inconsistent definitions for unplanned dialysis. High-quality data on patient risk factors for unplanned dialysis are lacking.Conclusions:Well-designed prospective studies to determine modifiable risk factors are needed. The lack of a consensus definition for unplanned dialysis makes research and quality improvement initiatives in this area more challenging.

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Section: Resultsmentioning

confidence: 99%

“…13 No randomized control trials were found in the search. The majority of studies were conducted in Europe (n = 26; 22 unique cohorts) 2,8,9,15-19,22-25,29,30,33,36,40-43,45-48,50,51 ; 11 studies were conducted in North America 3-6,14,21,26,28,31,52,53 (Canada, n = 9; 8 unique cohorts). Study cohort sizes ranged from 43 to 45 785 persons.…”

Section: Resultsmentioning

confidence: 99%

Risk Factors for Unplanned Dialysis Initiation: A Systematic Review of the Literature

Hassan

Akbari

Brown

et al. 2019

Can J Kidney Health Dis

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“…Patient education has been shown to help significantly improve KRT outcomes. A structured, patientcentered education program significantly increased the frequency of opting for PD in patients needing unplanned KRT in Germany [14]. A retrospective analysis conducted in South Korea, using propensity score matching, showed that patients who received multidisciplinary pre-dialysis education, compared with those who did not, commenced dialysis at a higher GFR and had less need for urgent unplanned dialysis [15].…”

Section: Discussionmentioning

confidence: 99%

Chronic Kidney Disease Education Class Improves Rates of Early Access Creation and Peritoneal Dialysis Enrollment

Aloudah¹,

Alanazi²,

Alrehaily³

et al. 2022

Cureus

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BackgroundMost patients with end-stage kidney disease begin hemodialysis (HD) in an unplanned fashion at a late stage, necessitating the commencement of HD with a temporary venous catheter, the least favorable option. Alternative modalities of kidney replacement therapy (KRT), peritoneal dialysis (PD), and preemptive transplant offer similar or better outcomes than HD at a lower overall cost, and yet they remain underutilized in Saudi Arabia. Early education may help prepare patients with advanced chronic kidney disease (CKD IV and V) to accept their disease and choose a KRT modality that minimizes complications and matches their lifestyle.The aim of the study is to assess the impact of a pilot educational class on therapy choices and outcomes. MethodologyIn a cross-sectional study, we conducted phone interviews and reviewed medical records of 81 attendees of the multidisciplinary monthly educational class about KRT that was held at the King Abdulaziz Medical City (KAMC) from January 2017 to October 2021. The interview was conducted at least one year after the participants attended the class. The study proposal, consent, and questionnaire were approved by the King Abdulaziz International Medical Research Center. Patient data was retrieved from KAMC electronic medical record system. ResultsVolunteer participation in the survey was high (62/81). For the respondents, a preemptive kidney transplant was the most preferred (48/62, 77%) option for KRT. Among the preferred fallback options, HD was the most frequently chosen (29/62, 47%) compared to PD (26/62, 41.9%). At the time of the interview, a great majority of the patients (54/62, 87%) was already on KRT, including about half (26/54, 48%) on HD via a catheter, and the rest about equally divided between those on HD via an arteriovenous (AF) fistula (13/54, 24%) and those on PD (15/54, 28%). Thus, half of the respondents on KRT (28/54, 51%) avoided urgent HD catheter commencement. However, because of an unfortunate shortage of donors, only a small minority (2/62, 3%) of patients received preemptive transplantation. ConclusionThe KAMC CKD education class helped boost the fraction of patients, significantly above the national average, who accepted the diagnosis of kidney failure and pursued preemptive native HD access or enrolled in PD.

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“…Nonetheless, expedited dialysis modality education should be provided and, if possible, family members should be involved in the decision-making process. Providing dialysis education considerably increases the use of PD, even in unplanned dialysis initiation [2,29]. In a retrospective study, patients starting urgent home-dialysis increased from 13% to 35% after implantation of in-hospital education program [2].…”

Section: Dialysis Modality Educationmentioning

confidence: 99%

How To Build a Successful Urgent-Start Peritoneal Dialysis Program

Rajora

Shastri

Pirwani³

et al. 2020

Kidney360

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In-center hemodialysis (HD) remains the predominant dialysis therapy in patients with ESKD. Many patients with ESKD present in late stage, requiring urgent dialysis initiation, and the majority start HD with central venous catheters (CVCs), which are associated with poor outcomes and high cost of care. Peritoneal dialysis (PD) catheters can be safely placed in such patients with late-presenting ESKD, obviating the need for CVCs. PD can begin almost immediately in the recumbent position, using low fill volumes. Such PD initiations, commencing within 2 weeks of the catheter placement, are termed urgent-start PD (USPD). Most patients with an intact peritoneal cavity and stable home situation are eligible for USPD. Although there is a small risk of PD catheter–related mechanical complications, most can be managed conservatively. Moreover, overall outcomes of USPD are comparable to those with planned PD initiations, in contrast to the high rate of catheter-related infections and bacteremia associated with urgent-start HD. The ongoing coronavirus disease 2019 pandemic has further exposed the vulnerability of patients with ESKD getting in-center HD. PD can mitigate the risk of infection by reducing environmental exposure to the virus. Thus, USPD is a safe and cost-effective option for unplanned dialysis initiation in patients with late-presenting ESKD. To develop a successful USPD program, a strong infrastructure with clear pathways is essential. Coordination of care between nephrologists, surgeons or interventionalists, and hospital and PD center staff is imperative so that patient education, home visits, PD catheter placements, and urgent PD initiations are accomplished expeditiously. Implementation of urgent-start PD will help to increase PD use, reduce cost, and improve patient outcomes, and will be a step forward in fostering the goal set by the Advancing American Kidney Health initiative.

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Impact of an in-Hospital Patient Education Program on Choice of Renal Replacement Modality in Unplanned Dialysis Initiation

Cited by 13 publications

References 39 publications

Risk Factors for Unplanned Dialysis Initiation: A Systematic Review of the Literature

Risk Factors for Unplanned Dialysis Initiation: A Systematic Review of the Literature

Chronic Kidney Disease Education Class Improves Rates of Early Access Creation and Peritoneal Dialysis Enrollment

How To Build a Successful Urgent-Start Peritoneal Dialysis Program

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