Preemptive assessment of self-care peritoneal dialysis ability significantly increased PD selection compared with standard education (54.6% vs 38.3%; RD 16.3%, 95% CI 4.4%-28.2%; P=0.007).
RCT (n=263)
Randomized
Does preemptive assessment of self-care PD ability increase the choice for peritoneal dialysis in ESKD patients approaching dialysis?
Preemptive assessment of self-care ability for peritoneal dialysis significantly increases the likelihood of patients choosing this modality.
Effect estimate: RD 16.3% (95% CI 4.4%-28.2%)
Absolute Event Rate: 54.6% vs 38.3%
p-value: p=0.007
Abstract Background Peritoneal dialysis (PD) relies on the patients’ efforts to conduct the procedure at home. Uncertainty about their ability to perform PD tasks may deter patients from choosing this modality. We conducted a randomized controlled trial to investigate the impact of preemptive evaluation of self-care PD ability on changing PD uptake. Methods End-stage kidney disease (ESKD) patients approaching dialysis with no definite contraindications for PD were recruited and randomized to control or intervention group. Both groups received kidney replacement therapy (KRT)-targeted education using a shared decision-making approach. Patients in the intervention group underwent additional self-care PD competency assessment, which was conducted by the same team of nephrologists and PD nurses, along with a close family member. Patients were followed until their final dialysis modality was decided or 6 months after enrollment. The primary study outcome was change in PD choice. Results A total of 263 patients were recruited and followed for 45 (IQR: 33-51) days. A significant higher rate of PD selection was demonstrated in the intervention group compared with the control group (54.6% 95% CI: 45.7%-63.4% vs. 38.3% 95% CI: 30.1%-47.2%, P=0.008; risk difference = 16.3%, 95% CI: 4.4%-28.2%, P=0.007) in the intention-to-treat analysis. Multivariable logistic analysis revealed that preemptive self-care PD competency assessment (Odds ratio OR=2.04, 95% CI: 1.19-3.50, P=0.010), prior knowledge of KRT (OR=2.09, 95% CI: 1.13-3.89, P=0.021) and higher education level (OR=3.11, 95% CI: 1.18-8.16, P=0.021, ref: illiterate/primary school) were independent determinants associated with an increased likelihood of PD choice. There was no significant difference in the assessment results of self-care PD ability between patients who chose PD and those who selected hemodialysis. Conclusions Preemptive assessment of self-care PD ability, which provides advance information on the feasibility of independent PD or the need for assisted PD, significantly increases PD selection among ESKD patients.
Lu et al. (Thu,) conducted a rct in End-stage kidney disease (ESKD) (n=263). Preemptive assessment of self-care PD ability vs. Standard KRT-targeted education was evaluated on Change in PD choice (RD 16.3%, 95% CI 4.4%-28.2%, p=0.007). Preemptive assessment of self-care peritoneal dialysis ability significantly increased PD selection compared with standard education (54.6% vs 38.3%; RD 16.3%, 95% CI 4.4%-28.2%; P=0.007).