Influence of formalized Predialysis Education Program (fPEP) on the chosen and definitive renal replacement therapy option

Abstract

Background. It is widely accepted that patients with chronic kidney disease (CKD) should play an active role in the selection of renal replacement therapy (RRT) option. However, patients' knowledge about CKD and treatment options is limited. The implementation of structured education program and shared decisionmaking may result in a better preparation to RRT, more balanced choice of dialysis modalities and better access to kidney transplantation (TX).Objectives. The aim of this long-term study was to assess the impact of formalized Predialysis Education Program (fPEP) on knowlege on RRT options, as well as on selected and definitive therapy. Materials and methods.The study included 435 patients (53% men, mean age 60 years) with CKD stage 4 and 5, participating in fPEP at our center. The program included at least 3 visits, during which balanced information about all RRT options was presented and self-care and informed decision-making were encouraged. The knowledge about RRT options before and after fPEP attendance, and selected and definitive RRT options were assessed.Results. Ninety-two percent of patients received prior nephrology care. After fPEP completion, in most patients, the knowledge about CKD and RRT options and selected preferred modality improved -40% of participants chose hemodialysis (HD), 32% peritoneal dialysis (PD) and 18% TX. During the observation period, 4% of patients died before commencement of dialysis, 2.7% received preemptive kidney transplant, 8.6% were placed on transplant waiting list, and 94% started dialysis (30% PD and 70% HD). Among those who chose PD, 69% started PD and 24% started HD; the leading causes of the discrepancy between choosing and receiving PD was the deterioration in clinical condition (50%) and change of decision (32%).Conclusions. The fPEP increases CKD patients' knowledge on RRT methods. The implementation of a decision-making process based on fPEP leads to a satisfying distribution between modalities, with a good concordance between chosen and definitive modality.

Impact of mobile application and outpatient follow-up on renal endpoints and physiological indices in patients with chronic kidney disease: a retrospective cohort study in Southwest China

“…In stage 4–5 of CKD, the kidneys are more severely damaged, often accompanied by uremia and other serious complications, including cardiovascular disease, osteoporosis, and anemia. When it is necessary to enter kidney replacement therapy, patients need to choose their treatment plan.The choice of RRT is a critical decision that has a great impact on the lives of both patients and their families, so it is advisable to practice shared decision-making when trying to choose the best treatment [ 30 , 31 ]. Face-to-face health education for outpatient follow-up could facilitate more communication and build better relationships between patients, family members, and healthcare team members [ 32 , 33 ].…”

Impacts of continuous quality improvement on wound pain in the puncture site of arteriovenous fistula in haemodialysis patient

“… 2 , 3 Despite advancements in transplant methods, the scarcity of donor kidneys limits accessibility. 4 , 5 , 6 Currently, HD and peritoneal dialysis are the predominant treatments globally, with HD accounting for ca. 69% of all renal replacement therapies and 89% of all dialysis treatments.…”

“…Approximately 2% of chronic kidney disease patients progress to end‐stage renal disease, necessitating renal replacement therapies like haemodialysis (HD) or kidney transplantation 2,3 . Despite advancements in transplant methods, the scarcity of donor kidneys limits accessibility 4–6 . Currently, HD and peritoneal dialysis are the predominant treatments globally, with HD accounting for ca.…”