NDT Advance Access originally published online on May 26, 2005
Nephrology Dialysis Transplantation 2005 20(9):1842-1847; doi:10.1093/ndt/gfh905
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Influence of a Pre-Dialysis Education Programme (PDEP) on the mode of renal replacement therapy
Department of Nephrology, Cliniques Universitaires St Luc, Université catholique de Louvain, 1200 Brussels, Belgium
Correspondence and offprint requests to: Professor Eric Goffin, Department of Nephrology, Cliniques Universitaires St Luc, Av Hippocrate 10, 1200 Brussels, Belgium. Email: goffin{at}nefr.ucl.ac.be
Background. The distribution of renal replacement therapy (RRT) modalities among patients varies from country to country, and is often influenced by non-medical factors. In our department, patients progressing towards end-stage renal disease (ESRD) go through a structured Pre-Dialysis Education Programme (PDEP). The goals of the programme, based on both individualized information session(s) given by an experienced nurse to the patient and family and the use of in-house audio-visual tapes, are to inform on all modalities of RRT, in order to decrease anxiety and promote self-care RRT modalities.
Methods. To evaluate the influence of our PDEP on the choice of RRT modalities, we retrospectively reviewed the modalities chosen by all consecutive patients starting a first RRT in our institution between December 1994 and March 2000.
Results. Two hundred and forty-two patients started a first RRT during the study period. Fifty-seven patients, median age 66 (24–80) years, were directed towards in-centre haemodialysis (HD) for medical or psycho-social reasons (seven of whom were not involved in the PDEP); the remaining 185 patients, median age 53 (7–81) years, with no major medical complications, went through our PDEP. Eight of them (4%) received a pre-emptive renal transplantation. The therapeutic options of the other 177 patients were as follows: 75 (40%) patients, median age 65 (20–81) years opted for in-centre HD, while 102 patients opted for a self-care modality; 55 (31%) patients, median age 56 (7–77) years, chose peritoneal dialysis, 30 (16%) patients, median age 49 (21–68) years, chose to perform self-care HD in our satellite unit, and 17 (9%) patients, median age 46 (19–70) years, opted for home HD. Interestingly, in the whole cohort of patients, the cause of ESRD was associated with the RRT modality: the proportion of patients with chronic glomerulonephritis or chronic interstitial nephritis on self-care therapy was significantly higher than that of patients with nephrosclerosis, diabetic nephropathy or unknown cause of ESRD.
Conclusion. In our centre offering all treatment RRT modalities, a high percentage of patients exposed to a structured PDEP start with a self-care RRT modality. This leaves in-centre HD for patients needing medical and nursing care, or for patients refusing to participate in their treatment. Additional large studies, preferably with a randomized design, should delineate the cost-benefit of such a PDEP on the final choice of a RRT modality.
Keywords: autodialysis; end-stage renal disease; haemodialysis; patient education; peritoneal dialysis; self-care dialysis
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