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NDT Advance Access published online on June 2, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp259
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Multidisciplinary predialysis education decreases the incidence of dialysis and reduces mortality—a controlled cohort study based on the NKF/DOQI guidelines

I-Wen Wu1,2, Shun-Yin Wang1, Kuang-Hung Hsu3, Chin-Chan Lee1,2, Chiao-Yin Sun1,2, Chi-Jen Tsai1,2 and Mai-Szu Wu1,2

1 Department of Nephrology, Chang Gung Memorial Hospital, Keelung 2 School of Medicine, Chang Gung University 3 Laboratory of Epidemiology, Department of Health Care Management, Chang Gung University, Taipei, Taiwan

Correspondence and offprint requests to: Mai-Szu Wu; E-mail: maxwu1{at}adm.cgmh.org.tw



  Abstract

Background. Observational studies have demonstrated that multidisciplinary predialysis education (MPE) improves the post-dialysis outcomes of chronic kidney disease (CKD) patients. However, the beneficial effect of MPE remains unclear in prospective controlled studies.

Methods. All CKD patients who visited the outpatient nephrology clinics at two centres of the Chang Gung Memorial Hospital in 2006–07 were enrolled. The incidence of dialysis and mortality were compared between MPE recipients and non-recipients. The content of the MPE was standardized in accordance with the NKF/DOQI guidelines. Prognostic factors for progression to end-stage renal disease (ESRD) and all-cause mortality were analysed by using the Cox proportional hazards model.

Results. Of 573 patients, 287 received MPE. Dialysis was initiated in 13.9% and 43% of the patients in the MPE and non-MPE groups, respectively (P < 0.001). The mean follow-up period was 11.7 ± 0.9 months. The overall mortality was 1.7% and 10.1% in the MPE and non-MPE groups, respectively (P < 0.001). Cox regression analysis revealed that diabetes, estimated glomerular filtration rate (eGFR), high-sensitive C-reactive protein (hs-CRP) and MPE assignment were significant independent predictors for progression to ESRD. Independent prognostic factors for mortality included age, diabetes, eGFR, hs-CRP and MPE assignment.

Conclusions. MPE based on the NKF/DOQI guidelines may decrease the incidence of dialysis and reduce mortality in late-stage CKD patients.

Keywords: chronic kidney disease; end-stage renal disease; multidisciplinary predialysis care; peritoneal dialysis

Received for publication: 9. 9.08
Accepted in revised form: 6. 5.09


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