Educating end-stage renal disease patients on dialysis modality selection

Covic, Adrian; Bammens, Bert; Lobbedez, Thierry; Segall, Liviu; Heimbürger, Olof; Biesen, Wim Van; Fouque, Denis; Vanholder, Raymond

doi:10.1093/ndtplus/sfq059

Cited by 30 publications

(35 citation statements)

References 95 publications

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“…In the present study, ~80% of both HD-AVF and PD patients were referred to the nephologist early and experienced similarly high survival rates in the first year of dialysis, compared to HD-TCC patients. Our results support the need for early referral of ESRD patients to nephrology centers to provide the opportunity for patient selection of RRT modality and timely creation of the appropriate dialysis access [22]. …”

Section: Discussionsupporting

confidence: 72%

Effects of starting hemodialysis with an arteriovenous fistula or central venous catheter compared with peritoneal dialysis: a retrospective cohort study

et al. 2012

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BackgroundAlthough several studies have demonstrated early survival advantages with peritoneal dialysis (PD) over hemodialysis (HD), the reason for the excess mortality observed among incident HD patients remains to be established, to our knowledge. This study explores the relationship between mortality and dialysis modality, focusing on the role of HD vascular access type at the time of dialysis initiation.MethodsA retrospective cohort study was performed among local adult chronic kidney disease patients who consecutively initiated PD and HD with a tunneled cuffed venous catheter (HD-TCC) or a functional arteriovenous fistula (HD-AVF) in our institution in the year 2008. A total of 152 patients were included in the final analysis (HD-AVF, n = 59; HD-TCC, n = 51; PD, n = 42). All cause and dialysis access-related morbidity/mortality were evaluated at one year. Univariate and multivariate analysis were used to compare the survival of PD patients with those who initiated HD with an AVF or with a TCC.ResultsCompared with PD patients, both HD-AVF and HD-TCC patients were more likely to be older (p<0.001) and to have a higher frequency of diabetes mellitus (p = 0.017) and cardiovascular disease (p = 0.020). Overall, HD-TCC patients were more likely to have clinical visits (p = 0.069), emergency room visits (p<0.001) and hospital admissions (p<0.001). At the end of follow-up, HD-TCC patients had a higher rate of dialysis access-related complications (1.53 vs. 0.93 vs. 0.64, per patient-year; p<0.001) and hospitalizations (0.47 vs. 0.07 vs. 0.14, per patient-year; p = 0.034) than HD-AVF and PD patients, respectively. The survival rates at one year were 96.6%, 74.5% and 97.6% for HD-AVF, HD-TCC and PD groups, respectively (p<0.001). In multivariate analysis, HD-TCC use at the time of dialysis initiation was the important factor associated with death (HR 16.128, 95%CI [1.431-181.778], p = 0.024).ConclusionOur results suggest that HD vascular access type at the time of renal replacement therapy initiation is an important modifier of the relationship between dialysis modality and survival among incident dialysis patients.

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Section: Discussionsupporting

confidence: 72%

Effects of starting hemodialysis with an arteriovenous fistula or central venous catheter compared with peritoneal dialysis: a retrospective cohort study

et al. 2012

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“…To prepare patients to make these decisions, European (Covic et al . ) and American (Saggi et al . ) guidelines recommend that renal replacement therapy option education (RRTOE) is provided.…”

Section: Introductionmentioning

confidence: 99%

Continuing Education: Preparing Patients to Choose a Renal Replacement Therapy

Goovaerts

Isnard

Crepaldi

et al. 2015

Journal of Renal Care

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SUMMARY Background Patients with progressive chronic kidney disease face a series of treatment decisions that will impact the quality of life of themselves and their family. Renal replacement therapy option education (RRTOE), generally provided by nurses, is recommended by international guidelines Objectives To provide nurses with advice and guidance on running RRTOE. Design A consensus conference. Participants Four nurses, 5 nephrologists and 1 clinical psychologist (9 renal units; 6 European countries) from units that had extensive experience in RRTOE or were performing research in this field. Approach Experts brainstormed and discussed quality standards for the education team, processes, content/topics, media/material/funding and quality measurements for RRTOE. Results Conclusions and recommendations from these discussions that are particularly pertinent to nurses are presented in this paper. Conclusions Through careful planning and smooth interdisciplinary cooperation, it is possible to implement an education and support programme that helps patients choose a form of RRT that is most suited to their needs. This may result in benefits in quality of life and clinical outcomes. Application to Practice There are large differences between renal units in terms of resources available and the demographics of the catchment area. Therefore, nurses should carefully consider how best to adapt the advice offered here to their own situation. Throughout this process, it is crucial to keep in mind the ultimate goal – providing patients with the knowledge and skill to make a modality choice that will enhance their quality of life to the greatest degree.

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“…31 In 2008 ERA-EDTA pointed out some criteria that may be used to recommend PD. 32 In particular, clinical conditions that may be usually identified in frail patients, such as aging complications, severe Cardiac Disease or Peripheral Vascular Disease, have been recognized as potential indicators for PD prescription. However, ERA-EDTA also identified factors with which use of PD may be contraindicated; these factors include inadequate patient's physical ability and lack of familiar or social support.…”

Section: Peritoneal Dialysismentioning

confidence: 99%