Offering Patients Therapy Options in Unplanned Start (OPTiONS): Implementation of an educational program is feasible and effective

BMC Nephrology

Research Article

Abdul Rashid Qureshi¹  Bengt Lindholm¹  Anna Machowska¹  Michael Koch²  Michael Aarup³  Peter Rutherford⁴  Mark Dominik Alscher⁵  Satyanarayana Reddy Vanga⁶ 

[1] Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, M99, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden;Nephrologisches Zentrum, Mettmann, Germany;Odense University Hospital, Odense, Denmark;Quintiles, Reading, UK;Robert-Bosch-Krankenhaus, Stuttgart, Germany;University Hospital of North Staffs, Stoke, UK;

关键词: Unplanned start;    Acute dialysis;    Education;   

DOI  :  10.1186/s12882-016-0419-z

 received in 2016-07-05, accepted in 2016-12-09,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundPatients with unplanned dialysis start (UPS) have worse clinical outcomes than non-UPS patients, and receive peritoneal dialysis (PD) less frequently. In the OPTiONS study of UPS patients, an educational programme (UPS-EP) aiming at improving care of UPS patients by facilitating care pathways and enabling informed choice of dialysis modality was implemented. We here report on impact of UPS-EP on modality choice and clinical outcomes in UPS patients.MethodsThis non-interventional, prospective, multi-center, observational study included 270 UPS patients from 26 centers in 6 European countries (Austria, Germany, Denmark, France, United Kingdom and Sweden) who prior to inclusion presented acutely, or were being followed by nephrologists but required urgent dialysis commencement by an acutely placed CVC or PD catheter. Effects of UPS-EP on choice and final decision of dialysis therapy and outcomes within 12 months of follow up were analysed.ResultsAmong 270 UPS patients who had an unplanned start to dialysis, 214 were able to receive and 203 complete UPS-EP while 56 patients - who were older (p = 0.01) and had higher Charlson comorbidity index (CCI; p < 0.01) - did not receive UPS-EP. Among 177 patients who chose dialysis modality after UPS-EP, 103 (58%) chose PD (but only 86% of them received PD) and 74 (42%) chose HD (95% received HD). Logistic regression analysis showed that diabetes 1.88 (1.05 – 3.37) and receiving UPS-EP, OR = 4.74 (CI, 2.05 – 10.98) predicted receipt of PD. Patients choosing PD had higher CCI (p = 0.01), higher prevalence of congestive heart failure (p < 0.01) and myocardial infarction (p = 0.02), and were more likely in-patients (p = 0.02) or referred from primary care (p = 0.02). One year survival did not differ significantly between PD and HD patients. Peritonitis and bacteraemia rates were better than international guideline standards.ConclusionsUPS-EP predicted patient use of PD but 14% of those choosing PD after UPS-EP still did not receive the modality they preferred. Patient survival in patients choosing and/or receiving PD was similar to HD despite age and comorbidity disadvantages of the PD groups.

【 授权许可】

CC BY   
© The Author(s). 2017