Education program increases peritoneal dialysis uptake in CKD patients
MedWire News: A pretreatment education program may increase the number of patients with chronic kidney disease (CKD) choosing home-based peritoneal dialysis (PD) over hospital-based hemodialysis (HD), US study data show.
The education program also resulted in fewer tunneled HD catheters and decreased mortality in the first 90 days of dialysis therapy, report Eduardo Lacson (Fresenius Medical Care North America [FMCNA], Waltham, Massachusetts) and colleagues in the American Journal of Kidney Diseases.
"The decrease in incidence and prevalence of home dialysis in the United States during the past 20 years has occurred despite data showing improving outcomes, higher patient satisfaction, lower overall cost with peritoneal dialysis (PD) therapy, and a perception by US nephrologists that home therapy is underused," the researchers remark.
In 2006, FMCNA launched the Treatment Options Programs (TOPs) to bridge the care gap for patients approaching the need for renal replacement therapy. Lacson et al explain that TOPs is a nationwide program that aims to educate patients with CKD about kidney transplant, in-center HD, home dialysis (PD and home HD), and conservative therapy.
In the present study, the researchers reviewed the rates of PD uptake, arteriovenous HD access at initiation, and early (90-day) mortality risk among patients starting dialysis at FMCNA centers during 2008.
Of 30,217 patients admitted with CKD during this time, 3156 (10.5%) attended TOPs.
Lacson and team found that significantly more TOPs attendees opted for PD compared with non-attendees, at 24.5% versus 3.7%.
Furthermore, logistic regression confirmed that TOPs attendees were a significant 8.5 times more likely to select PE therapy than non-attendees. Adjustment for age, gender, race, diabetes, comorbidity, body surface area, and albumin, hemoglobin, and phosphorus values slightly attenuated the association to give an odds ratio of 5.1.
TOPs attendance was also associated with a 2.1-fold increased likelihood of starting treatment with a fistula or graft in those who opted for in-hospital HD therapy, compared with non-attendance.
Finally, the researchers report that TOPs attendees had a 39% lower risk for early mortality than non-attendees after adjustment for the same potential confounding factors.
Discussing their findings, Lacson and co-authors caution that there was a risk for referral bias. "It is possible that physicians who referred to these programs were more likely to prescribe PD therapy or place arteriovenous accesses."
In addition, "motivated, treatment-adherent patients (who would have better outcomes) may have self-selected to attend education sessions," they write.
In spite of this, the researchers conclude that their report "supports providing widely-based predialysis patients with CKD and family members with an opportunity to attend sessions offering end-stage renal disease therapy options education."
By Laura Dean