Single-session pre-dialysis counseling program does not improve short-term outcomes of capd patients

Abstract

A multidisciplinary education program is an attractive approach for improving the quality of care of pre-dialysis patients. However, it is not known whether this kind of program can reduce the need for urgent dialysis and/or hospitalizations in patients who subsequently receive continuous ambulatory peritoneal dialysis (CAPD). In October 1995, we began a multidisciplinary pre-dialysis education program for patients with plasma creatinine levels > 500 μmol/L or creatinine clearances < 15 ml/min. The program involved a single-session, intensive, educational presentation and discussion pertaining to the initiation of dialysis, modality selection, and access creation. From October 1995 to December 1997, 145 patients were enrolled in the CAPD program at our center, 67 of whom that had attended this pre-dialysis counseling program were included in this study (PDP group). Their short-term morbidity was compared to 58 CAPD patients who were referred late to a during the same period (LR group). They were also compared to 51 CAPD patients enrolled from January 1993 to September 1995 who received standard outpatient nephrology care prior to dialysis (SC group). All three groups of patients were comparable with regard to age, sex, underlying renal disease, and comorbid conditions. The LR group showed a higher incidence of requiring urgent dialysis (86.2% vs. 50.7% and 60.8% for the PDP and SC groups, respectively p < 0.001. The LR group also required more hospitalizations during the first 6 months of dialysis (median = 25 days, vs. 16 and 15 days for the PDP and SC groups, respectively, p < 0.001). There was no difference with regard to the need for urgent dialysis or hospitalizations between patients in the PDP and SC groups. There were no differences among the three groups with regard to the rate of peritonitis, exit site infections, or hemoglobin, albumin, phosphate, and parathyroid hormone levels. We conclude that in a referral hospital setting, a single-session, intensive, pre-dialysis counseling program offers no additional advantage in short-term patient outcome over standard outpatient nephrology care. Repeated explanation and follow-up education are necessary. Since a significant proportion of pre-dialysis patients is referred late to a nephrologist, education programs targeted to primary care physicians and other medical specialists are important.