Predialysis education program and early vascular access: a single center experience

Year 2023, , 355 - 359, 27.10.2023

Mahmud İslam , Kenan Evren Öztop

https://doi.org/10.38053/acmj.1331260

Abstract

Aims: The main objective of this study is to investigate the impact of a pre-dialysis education program on the selection of vascular access during the initiation of maintenance hemodialysis therapy and the short-term impact of this education on patient outcomes.
Methods: The data were collected from two different times in the past from patients under maintenance hemodialysis: the first group consisted of a group of patients who received a predialysis education program (intervention group) from a dedicated nephrologist, and the second group included those who did not undergo a control program (control group). Predialysis education program involved six modules addressing understanding kidney disease, diet, and nutrition, treatment options for end-stage kidney disease, dialysis procedures, medication management, and self-care/independence. Patients aged ≥18 years were enrolled in the study. The patients were compared according to their clinical status during the onset of maintenance hemodialysis, including vascular access type, serum potassium level, previous hospitalization, and urgent hemodialysis need. Additionally, the hospitalization and infection rates within 6 months following the onset of maintenance hemodialysis were compared. P<0.05 was assigned as significant.
Results: A total of 203 hemodialysis patients, 129 patients in the intervention group and 74 patients in the control group, were assessed. The mean age was 65.06±13.14 for the intervention versus 65.66±9.13 for the control group (p=0.729). 51.9% (n=67) in the intervention group versus 55.4% (n=41) were females (p=0.371). The control group had more hospitalization (p<0.001), intervention need of vascular access problems (p<0.001), vascular access infection (<0.001), exposure to an intermittent catheter (<0.001), 127 of 129 patients in the intervention group started hemodialysis with an arteriovenous fistula. The control group started hemodialysis with a catheter Potassium, phosphorus, and bicarbonate levels were higher in the control group during the first hemodialysis session (5.25±1.12 vs 4.59±0.79, p<0.001, 6.60±1.18 vs 4.25±1.04, p<0.001, and 21.77±3.96 vs 14.18±2.83, p<0.001, respectively).
Conclusion: This study demonstrated that a well-organized education program can lower the burden of morbidity in end-stage kidney disease and support the patient and healthcare providers with a favorable transmission from a non-hemodialysis period to a hemodialysis period.

Keywords

End-stage kidney disease, pre-dialysis education, maintenance hemodialysis, morbidity, vascular access

Thanks

Warm thanks to the predialysis educational program moderator nurse Betul Turkoglu for her endless efforts in education and data collection. We also thank Prof. Dr. Hamad Dheir for his ideas in the conceptualization of the study along with guidance. Special thanks to Dr. Hasan Tosun medical director of Zonguldak state hospital and his cabinet especially Zeynep Güner for their logistic support of the education program.

References

• Hill NR, Fatoba ST, Oke JL, Hirst JA, et al. Global prevalence of chronic kidney disease - a systematic review and meta-analysis. PLoS One. 2016;11(7):e0158765.
• Glassock RJ, Warnock DG, Delanaye P. The global burden of chronic kidney disease: estimates, variability and pitfalls. Nat Rev Nephrol. 2017;13(2):104-114.
• Fluck R, Kumwenda M. Renal Association Clinical Practice Guideline on vascular access for haemodialysis. Nephron Clin Pract. 2011;118 Suppl 1:c225-c240.
• Hoggard J, Saad T, Schon D, et al. Guidelines for venous access in patients with chronic kidney disease. A Position Statement from the American Society of Diagnostic and Interventional Nephrology, Clinical Practice Committee and the Association for Vascular Access. Semin Dial. 2008;21(2):186-191.
• Levin A, Lewis M, Mortiboy P, et al. Multidisciplinary predialysis programs: quantification and limitations of their impact on patient outcomes in two Canadian settings. Am J Kidney Dis. 1997;29(4):533-540.
• Chanouzas D, Ng KP, Fallouh B, Baharani J. What influences patient choice of treatment modality at the pre-dialysis stage? Nephrol Dial Transplant. 2012;27(4):1542-1547.
• Van den Bosch J, Warren DS, Rutherford PA. Review of predialysis education programs: a need for standardization. Patient Prefer Adherence. 2015;9:1279-1291.
• Lin MY, Cheng LJ, Chiu YW, et al. Effect of national pre-ESRD care program on expenditures and mortality in incident dialysis patients: a population-based study. PLoS One. 2018;13(6):e0198387.
• Campbell-Montalvo R, Jia H, Shukla AM. Supporting shared decision-making and home dialysis in end-stage kidney disease. Int J Nephrol Renovasc Dis. 2022;15:229-237.
• Kalantar-Zadeh K, Lockwood MB, Rhee CM, et al. Patient-centred approaches for the management of unpleasant symptoms in kidney disease. Nat Rev Nephrol. 2022;18(3):185-198.
• Murea M, Grey CR, Lok CE. Shared decision-making in hemodialysis vascular access practice. Kidney Int. 2021;100(4): 799-808.
• Combes G, Sein K, Allen K. How does pre-dialysis education need to change? findings from a qualitative study with staff and patients. BMC Nephrol. 2017;18(1):334.
• Jia T, Bi SH, Lindholm B, Wang T. Effect of multi-dimensional education on disease progression in pre-dialysis patients in China. Ren Fail. 2012;34(1):47-52.
• Singhal R, Hux JE, Alibhai SMH, Oliver MJ. Inadequate predialysis care and mortality after initiation of renal replacement therapy. Kidney Int. 2014;86(2):399-406.
• Craig JC, Molony DA, Strippoli GFM. Evidence-Based Nephrology, 2 Volume Set. John Wiley & Sons; 2022.
• Dsouza B, Prabhu R, Unnikrishnan B, et al. Effect of educational intervention on knowledge and level of adherence among hemodialysis patients: a randomized controlled trial. Glob Health Epidemiol Genom. 2023;2023:4295613.
• Saran R, Bragg-Gresham JL, Rayner HC, et al. Nonadherence in hemodialysis: associations with mortality, hospitalization, and practice patterns in the DOPPS. Kidney Int. 2003;64(1):254-262.
• Parvan K, Hasankhani H, Seyyedrasooli A, Riahi SM, Ghorbani M. The effect of two educational methods on knowledge and adherence to treatment in hemodialysis patients: clinical trial. J Caring Sci. 2015;4(1):83-93.
• Tarverdizade Asl P, Lakdizaji S, Ghahramanian A, Seyedrasooli A, Ghavipanjeh Rezaiy S. Effectiveness of text messaging and face to face training on improving knowledge and quality of life of patients undergoing hemodialysis: a randomized clinical trial. J Caring Sci. 2018;7(2):95-100.
• Shimizu Y, Nakata J, Yanagisawa N, et al. Emergent initiation of dialysis is related to an increase in both mortality and medical costs. Sci Rep. 2020;10(1):19638.