Patient education and access of ESRD patients to renal replacement therapies beyond in-center hemodialysis

Kidney Int. 2005 Jul;68(1):378-90. doi: 10.1111/j.1523-1755.2005.00453.x.


Background: Nephrologists report that patients' choice should play an important role in the selection of renal replacement therapy (RRT) for end-stage renal disease (ESRD). In the United States, kidney transplant rates remain low and <10% of patients utilize home dialysis therapies. This study examined the effect of pre-ESRD processes on the selection of RRT among incident ESRD patients.

Methods: Using surveys, data were collected for all patients admitted to 229 dialysis units in ESRD Network 18 between April 1, 2002 and May 31, 2002. A total of 1365 patients began chronic dialysis and 1193 facility (87%) and 428 patient (31%) surveys were returned.

Results: Substantial proportions of patients were unaware of their kidney disease (36%) or were not seeing a nephrologist (36%) until <4 months before first dialysis. The presentation of treatment options was delayed (48% either after or < 1 month before the first dialysis). The majority of ESRD patients were not presented with chronic peritoneal dialysis, home hemodialysis, or renal transplantation as options (66%, 88%, and 74%, respectively). Using multivariate analyses, variables significantly associated with selection of chronic peritoneal dialysis as dialysis modality were the probability of chronic peritoneal dialysis being presented as a treatment option and the time spent on patient education.

Conclusion: An incomplete presentation of treatment options is an important reason for under-utilization of home dialysis therapies and probably delays access to transplantation. Improvements in and reimbursement for pre-ESRD education could provide an equal and timely access for all medically suitable patients to various RRTs.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Data Collection
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Hemodialysis, Home / psychology
  • Hemodialysis, Home / statistics & numerical data
  • Humans
  • Kidney Failure, Chronic / psychology*
  • Kidney Failure, Chronic / therapy*
  • Kidney Transplantation / psychology
  • Kidney Transplantation / statistics & numerical data
  • Male
  • Middle Aged
  • Nephrology / statistics & numerical data
  • Patient Education as Topic / statistics & numerical data*
  • Patient Satisfaction
  • Peritoneal Dialysis / psychology
  • Peritoneal Dialysis / statistics & numerical data
  • Referral and Consultation / statistics & numerical data
  • Renal Replacement Therapy / psychology*
  • Renal Replacement Therapy / statistics & numerical data
  • Surveys and Questionnaires