Predialysis psychoeducational intervention and coping styles influence time to dialysis in chronic kidney disease

Am J Kidney Dis. 2003 Oct;42(4):693-703. doi: 10.1016/s0272-6386(03)00835-7.


Background: Consensus endorses predialysis intervention before the onset of end-stage renal disease. In a previous study, predialysis psychoeducational intervention (PPI) extended time to dialysis therapy by a median of 6 months. We undertook to replicate and extend this finding by examining hypothesized mechanisms.

Methods: We used an inception-cohort, prospective, randomized, controlled trial with follow-up to evaluate an intervention that included an interactive 1-on-1 slide-supported educational session, a printed summary (booklet), and supportive telephone calls once every 3 weeks. Participants were sampled from 15 Canadian (tertiary care) nephrology units and included 297 patients with progressive chronic kidney disease (CKD) expected to require renal replacement therapy (RRT) within 6 to 18 months. The main outcome was time to dialysis therapy (censored at 18 months if still awaiting RRT).

Results: Time to dialysis therapy was significantly longer (median, 17.0 months) for the PPI group than the usual-care control group (median, 14.2 months; Cox's proportional hazards analysis, controlling for general nonrenal health, P < 0.001). Coping by avoidance of threat-related information (called blunting) was associated with shorter times to dialysis therapy (P < 0.032). A group x blunting interaction (P < 0.069) indicated: (1) time to dialysis therapy was shortened in the usual-care group, especially when patients coped by blunting; but (2) time to dialysis therapy was extended with PPI, even among patients who coped by blunting. Knowledge acquisition predicted time to dialysis therapy (r = 0.14; P < 0.013). Time to dialysis therapy was unrelated to depression or social support.

Conclusion: PPI extends time to dialysis therapy in patients with progressive CKD. The mechanism may involve the acquisition and implementation of illness-related knowledge. Routine follow-up also may be especially important when patients cope by avoiding threat-related information.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological*
  • Anxiety / diagnosis
  • Biomarkers / blood
  • Cohort Studies
  • Creatinine / blood
  • Depression / diagnosis
  • Disease Progression
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Kidney Failure, Chronic / psychology*
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Patient Education as Topic / methods*
  • Prospective Studies
  • Renal Replacement Therapy / methods
  • Renal Replacement Therapy / psychology*
  • Reproducibility of Results
  • Social Support
  • Time Factors


  • Biomarkers
  • Creatinine