Shukla Ashutosh M, Easom Andrea, Singh Manisha, Pandey Richa, Rotaru Dumitru, Wen Xuerong, Shah Sudhir V
North Florida/South Georgia Veteran Healthcare System, Gainesville, FL, USA
University of Florida, Gainesville, FL, USA.
Perit Dial Int. 2017 Sep-Oct;37(5):542-547. doi: 10.3747/pdi.2016.00270. Epub 2017 May 25.
Improvement in the rates of home dialysis has been a desirable but difficult-to-achieve target for United States nephrology. Provision of comprehensive predialysis education (CPE) in institutes with established home dialysis programs has been shown to facilitate a higher home dialysis choice amongst chronic kidney disease (CKD) patients. Unfortunately, limited data have shown the efficacy of such programs in the United States or in institutes with small home dialysis (HoD) programs.
We report the retrospective findings examining the efficacy of a CPE program in the early period after its establishment, with reference to its impact on the choice and growth of a small HoD program.
Over the initial 22 months since its inception, 108 patients were enrolled in the CPE clinic. Seventy percent of patients receiving CPE chose HoD, of which 55% chose peritoneal dialysis (PD) and 15% chose home hemodialysis (HHD). Rates of HoD choice were similar across the spectrum of socio-economic variables. Of just over half (54.6%) of those choosing to return for more than 1 session, 25.3%, changed their modality preference after the first education session, and nearly all reached a final modality selection by the end of the third visit. Initiation of the CPE program resulted in a 216% growth in HoD census over the same period and resulted in near doubling of HoD prevalence to 38% of all dialysis patients.
Comprehensive patient education improves the choice and prevalence of HoD therapies. We further find that 3 sessions of CPE may provide needed resources for the large majority of subjects for adequate decision-making.
提高家庭透析率一直是美国肾脏病学领域一个理想但难以实现的目标。在已建立家庭透析项目的机构中提供全面的透析前教育（CPE）已被证明有助于慢性肾脏病（CKD）患者做出更高比例的家庭透析选择。不幸的是，在美国或家庭透析（HoD）项目规模较小的机构中，关于此类项目有效性的数据有限。
我们报告了一项回顾性研究结果，该研究考察了一个CPE项目在建立初期的有效性，并参考了其对一个小型HoD项目的选择和发展的影响。
自该项目启动后的最初22个月里，有108名患者参加了CPE诊所。接受CPE的患者中有70%选择了家庭透析，其中55%选择了腹膜透析（PD），15%选择了家庭血液透析（HHD）。在社会经济变量范围内，家庭透析的选择率相似。在选择回访超过1次的患者中，略超过一半（54.6%）的患者中，有25.3%在第一次教育课程后改变了他们的透析方式偏好，几乎所有患者在第三次就诊结束时都做出了最终的透析方式选择。CPE项目的启动导致同期家庭透析患者数量增长了216%，家庭透析患病率几乎翻了一番，达到所有透析患者的38%。
全面的患者教育提高了家庭透析治疗的选择率和患病率。我们进一步发现，三次CPE课程可能为大多数受试者提供做出充分决策所需的资源。
