Customized versus Conventional Video Counseling for Peritoneal Dialysis Decision-making in Chronic Kidney Disease Stage 5 under PD First Policy, A Randomized Controlled Study

Abstract

Purpose Un-decision for start peritoneal dialysis (PD) was a challenging problem with conventional video counseling in CKD stage 5. This study aims to evaluate customized (for local context) versus conventional video counseling for PD decision-making in CKD stage 5 under PD first policy. Methods In 120 CKD stage 5 in tertiary-care hospital, Thailand who indicated initiate PD between May 2016 to January 2017 were enrolled in a randomized, open-label, controlled study. Patients were randomized to customized and conventional video counseling. The primary outcome was the acceptance rate along with PD catheter insertion on schedule. The secondary outcomes included changing the patient’s knowledge and confidence in PD and unplanned start PD rate. Results 120 patients were analyzed (customized n=60; conventional n=60). The two groups were similar for age (55.7±12.3 vs. 56.2±13.4 years), BUN (89.8±30.8 vs. 86.8±29.5 mg/dL), Cr (10.37±5.39 vs. 11.29+4.90 mg/dl) and eGFR (4.78+2.79 vs. 5.62+2.82 mL/min/1.73m2). Acceptance rate along with PD catheter insertion on the schedule in customized video counselling group was not significant difference with conventional video counselling group (66.6% vs. 63.3%, relative risk 0.97, 95% confidence interval 0.73 to 1.29, p = 0.86). Patient’s knowledge and confidence in PD were increasing but not significant difference between both groups. Conclusions Among CKD stage 5 in PD first policy, customized counseling was not a significant difference in rate of accept for start PD along with PD catheter insertion on schedule with conventional video counseling. Other counseling method to improve the accept rate for start PD need to further investigation.