How pre-education affects patients choosing appropriate renal replacement treatment: a retrospective study

Worldwide, only 11% of dialysis patients are treated by peritoneal dialysis (PD), however many of those treated by haemodialysis (HD) do not receive any pre-dialysis education thereby excluding informed choice. Just over 4% of such patients are treated by PD in Poland. This study retrospectively evaluates the impact of pre-education on patient decisions made for renal replacement therapy to determine those factors that limit making PD as the treatment of choice in Poland.

Subjects were 118 patients having received pre-dialysis education for over 3 years consisting of a fixed scheduled meeting lasting 1.5-2.0 h, according to patient needs, during routine work at a PD clinic in Warsaw. Subjects were broken down into groupings according to demographics, clinical features, lifestyle/domestic conditions and criteria used for PD/HD inclusions to determine significant factors affecting treatment choice by using parametric or non-parametric significance testing as appropriate. Significant associations were determined by univariate logistic regression.

No medical or psychosocial obstacles to PD treatment were found in 75 patients (63.5%), whereas relative contraindications were found 17 patients (14.4%), assisted dialysis was necessary in 19 patients (16.1%) and 7 patients (6.0%) were disqualified. PD was chosen by 74 patients (62.7%) and 44 patients (37.3%) decided on HD, where in the former group, PD treatment was actually undertaken in 61 (52%) of study subjects. Occupationally active people and retirees/pensioners chose PD more often and most patients (91.5%) declared having suitable home conditions for PD treatment. Factors significantly reducing prospects for PD were advanced age (p = 0.010), diabetes (p = 0.008), high BMI (p = 0.010), presence of scars from abdominal surgeries (p = 0.029) and reliance on third parties (p = 0.013).

Most subjects qualifying for renal replacement therapy had no contraindications for PD. Thanks to pre-dialysis education, > 50% could choose this treatment option. The main barriers found to having home-based renal replacement therapy were a lack of appropriate education and limited access to assisted PD.