Multidisciplinary predialysis education reduces incidence of peritonitis and subsequent death in peritoneal dialysis patients: 5-year cohort study

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Abstract

Background

Technique failure secondary to peritonitis is a grave impediment to remain in peritoneal dialysis (PD) therapy leading to high mortality. Multidisciplinary predialysis education (MPE) has shown improvement in outcomes of chronic kidney disease (CKD) patients. However, the legacy effects of MPE in PD patients remain unclear.

Methods

All patients who started PD at single hospital in 2007–16 were enrolled. The incidences of peritonitis and peritonitis-related mortality were compared between MPE recipients and non-recipients. The content of the MPE was standardized in accordance with the NKF/DOQI guidelines. Kaplan-Meier analysis and Cox proportional hazards model were applied to identify the prognostic factors associated with peritonitis-free survival.

Results

Of 398 PD patients, 169 patients had received MPE before starting PD. The patients of MPE group had a lower peritonitis rate [median (IQR) 0 (0.29) versus 0.11 (0.69) episodes/person-year, P< 0.001] and a lower percentage of peritonitis-related deaths (3.6% versus 8.7%, P = 0.04) compared with the non-MPE group. The median time to the first episode of peritonitis in the non-MPE and MPE groups was 33.9 months and 46.7 months, respectively (Cox-Mantel log rank test, P = 0.003). Cox regression analysis revealed that MPE assignment (HR: 0.594; 95% CI: 0.434–0.813, P< 0.001) were significant independent predictors for peritonitis-free survival.

Conclusions

An efficient standardized MPE program may prolong the time to the first episode of peritonitis and reduce peritonitis rate, independent of age, gender, diabetes, hypertension, educational status and PD modality. Subsequently, decreased peritonitis-related death.

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Most cited references 27

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The impact of education on chronic kidney disease patients' plans to initiate dialysis with self-care dialysis: a randomized trial.

Braden J. Manns, Ken Taub, Kevin McLaughlin … (2005)

Compared with in-center hemodialysis, self-care dialysis (including home and self-care hemodialysis and peritoneal dialysis) is less resource intensive and associated with similar clinical outcomes. However, utilization of self-care dialysis has been very low. We performed a randomized controlled trial in predialysis patients with chronic kidney disease (CKD) (GFR <30 mL/min) to determine the impact of a patient-centered educational intervention on patients' intention to initiate dialysis with self-care dialysis. Seventy patients with CKD who were receiving care in a multidisciplinary predialysis clinic were randomized to receive either (1) a two-phase patient-centered educational intervention (phase 1 included educational booklets and a 15-minute video on self-care dialysis; phase 2 included a 90-minute small group interactive educational session on self-care dialysis) in addition to their regular multidisciplinary care, or (2) ongoing standard care and education in the multidisciplinary predialysis clinic. The primary outcome was patients' intention to initiate dialysis with self-care dialysis, assessed by questionnaire. Thirty-five patients were randomized to standard care; 34 completed the study. Thirty-five patients were randomized to the educational intervention; 30 completed phase 1 and 28 completed phase 2. By study end, significantly more patients in the intervention group (82.1%) intended to start dialysis with self-care dialysis compared with the standard care group (50%, P= 0.015). This difference persisted after controlling for the small baseline differences among patients in the two study groups (P= 0.004). A two-phase educational intervention can increase the proportion of patients who intend to initiate dialysis with self-care dialysis.

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Multidisciplinary predialysis education decreases the incidence of dialysis and reduces mortality--a controlled cohort study based on the NKF/DOQI guidelines.

Shih-Jen Tsai, Chin Chin Lee, Chiao-Yin Sun … (2009)

Observational studies have demonstrated that multidisciplinary predialysis education (MPE) improves the post-dialysis outcomes of chronic kidney disease (CKD) patients. However, the beneficial effect of MPE remains unclear in prospective controlled studies. All CKD patients who visited the outpatient nephrology clinics at two centres of the Chang Gung Memorial Hospital in 2006-07 were enrolled. The incidence of dialysis and mortality were compared between MPE recipients and non-recipients. The content of the MPE was standardized in accordance with the NKF/DOQI guidelines. Prognostic factors for progression to end-stage renal disease (ESRD) and all-cause mortality were analysed by using the Cox proportional hazards model. Of 573 patients, 287 received MPE. Dialysis was initiated in 13.9% and 43% of the patients in the MPE and non-MPE groups, respectively (P < 0.001). The mean follow-up period was 11.7 +/- 0.9 months. The overall mortality was 1.7% and 10.1% in the MPE and non-MPE groups, respectively (P < 0.001). Cox regression analysis revealed that diabetes, estimated glomerular filtration rate (eGFR), high-sensitive C-reactive protein (hs-CRP) and MPE assignment were significant independent predictors for progression to ESRD. Independent prognostic factors for mortality included age, diabetes, eGFR, hs-CRP and MPE assignment. MPE based on the NKF/DOQI guidelines may decrease the incidence of dialysis and reduce mortality in late-stage CKD patients.

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Effectiveness of multidisciplinary care for chronic kidney disease in Taiwan: a 3-year prospective cohort study.

Shyang-Hwa Ferng, Liang-Chuan S Wang, Wen-Chi Chou … (2013)

Previous studies have demonstrated that multidisciplinary pre-dialysis education and team care may slow the decline in renal function for chronic kidney disease (CKD). Our study compared clinical outcomes of CKD patients between multidisciplinary care (MDC) and usual care in Taiwan. In this 3-year prospective cohort study from 2008 to 2010, we recruited 1056 CKD subjects, aged 20-80 years, from five hospitals, who received either MDC or usual care, had an estimated glomerular filtration rate (eGFR) <60 mL/min, were matched one to one with the propensity score including gender, age, eGFR and co-morbidity diseases. The MDC team was under-cared based on NKF K/DOQI clinical practice guidelines and the Taiwanese pre-end-stage renal disease (ESRD) care program. The incidence of progression to ESRD (initiation of dialysis) and mortality was compared between two groups. We also monitored blood pressure control, the rate of renal function decline, lipid profile, hematocrit and mineral bone disease control. Participants were prone to be male (64.8%) with a mean age of 65.1 years and 33.1 months of mean follow-up. The MDC group had higher prescription rates of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), phosphate binder, vitamin D3, uric acid lower agents and erythropoietin-stimulating therapy and better control in secondary hyperparathyroidism. The decline of renal function in advanced stage CKD IV and V was also slower in the MDC group (-5.1 versus -7.3 mL/min, P = 0.01). The use of temporary dialysis catheter was higher in the usual care group, and CKD patients under MDC intervention exhibited a greater willingness to choose peritoneal dialysis modality. A Cox regression revealed that the MDC group was associated with a 40% reduction in the risk of hospitalization due to infection, and a 51% reduction in patient mortality, but a 68% increase in the risk of initiation dialysis when compared with the usual care group. MDC patients were found to have more effective medication prescription according to K/DOQI guidelines and slower renal function declines in advanced/late-stage CKD. After MDC intervention, CKD patients had a better survival rate and were more likely to initiate renal replacement therapy (RRT) instead of mortality.

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Author and article information

Contributors

Cheng-Kai Hsu:

ORCID: http://orcid.org/0000-0002-6812-526X

Role: Data curationRole: Formal analysisRole: Writing – original draft

Chin-Chan Lee: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Writing – review & editing

Yih-Ting Chen: Role: Data curationRole: Formal analysis

Ming-Kuo Ting: Role: Data curation

Chiao-Yin Sun: Role: Data curationRole: Writing – review & editing

Chun-Yu Chen: Role: Data curationRole: Formal analysis

Heng-Jung Hsu: Role: Data curationRole: Formal analysis

Yung-Chang Chen: Role: Data curationRole: Formal analysis

I-Wen Wu:

ORCID: http://orcid.org/0000-0001-8535-3582

Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: ResourcesRole: SupervisionRole: Writing – review & editing

Tatsuo Shimosawa: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 23 August 2018

Publication date Collection: 2018

Volume: 13

Issue: 8

Electronic Location Identifier: e0202781

Affiliations

[1 ] Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan

[2 ] Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Keelung, Taiwan

[3 ] College of Medicine, Chang Gung University, Taoyuan, Taiwan

International University of Health and Welfare, School of Medicine, JAPAN

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: fliawu@ 123456yahoo.com

Author information

Cheng-Kai Hsu http://orcid.org/0000-0002-6812-526X

I-Wen Wu http://orcid.org/0000-0001-8535-3582

Article

Publisher ID: PONE-D-18-15950

DOI: 10.1371/journal.pone.0202781

PMC ID: 6107258

PubMed ID: 30138478

SO-VID: faddcaaf-1058-4c1f-ae6d-e0f99cde294b

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 28 May 2018

Date accepted : 8 August 2018

Page count

Figures: 2, Tables: 4, Pages: 12

Funding

Funded by: funder-id http://dx.doi.org/10.13039/100012553, Chang Gung Memorial Hospital;

Award ID: CMRPG260323, CMRPG2A0423, CMRPG2C0093 and CMRPG2E0232).

Award Recipient :

ORCID: http://orcid.org/0000-0001-8535-3582

I-Wen Wu

This study was sponsored by the Chang Gung Memorial Hospital Research Projects (CMRPG260323, CMRPG2A0423, CMRPG2C0093 and CMRPG2E0232) to I-WW. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Data Availability All relevant data are within the paper and its Supporting Information file.

Multidisciplinary predialysis education reduces incidence of peritonitis and subsequent death in peritoneal dialysis patients: 5-year cohort study

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Abstract

Background

Methods

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Conclusions

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PLOS Climate

Most cited references 27

The impact of education on chronic kidney disease patients' plans to initiate dialysis with self-care dialysis: a randomized trial.

Multidisciplinary predialysis education decreases the incidence of dialysis and reduces mortality--a controlled cohort study based on the NKF/DOQI guidelines.

Effectiveness of multidisciplinary care for chronic kidney disease in Taiwan: a 3-year prospective cohort study.

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