Inpatient educational program delays the need for dialysis in patients with chronic kidney disease stage G5
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ORIGINAL ARTICLE
Inpatient educational program delays the need for dialysis in patients with chronic kidney disease stage G5 Wei Han Takagi1 · Kiyomi Osako1 · Shinji Machida1 · Kenichiro Koitabashi1 · Yugo Shibagaki1 · Tsutomu Sakurada1 Received: 22 June 2020 / Accepted: 23 September 2020 © Japanese Society of Nephrology 2020
Abstract Background Inpatient educational programs (IEPs) for patients with chronic kidney disease (CKD) decrease CKD progression. However, patients with end-stage kidney disease who started dialysis during the observation period were excluded from previous studies. Methods After adjusting for age, sex, baseline estimated glomerular filtration rate, hemoglobin level, and the presence of diabetes mellitus using 1:1 propensity score matching (caliper width of 0.008) in the groups that did and did not receive an IEP, we compared the time period from the beginning of CKD stage G5 to the start of dialysis and patient characteristics at the start of dialysis. Results Prior to matching, 41 patients received an IEP and 260 did not. After propensity score matching, the 41 patients who received an IEP had a longer period from the beginning of stage G5 to the start of dialysis (344 vs. 257 days, P = 0.011), shorter hospitalization period upon the start of dialysis (14 vs. 18 days, P = 0.015) compared with the 41 patients who did not receive an IEP. In addition, the proportion of patients with a planned start of dialysis tended to be higher in the IEP group (95.1 vs. 83.0%, P = 0.077). Conclusion An IEP may delay the start of dialysis in patients with end-stage kidney disease, contribute to better preparation of vascular access placement and the smoother start of dialysis. Keywords Chronic kidney disease · Inpatient educational programs · End-stage kidney disease
Introduction The number of patients with chronic kidney disease (CKD) is increasing worldwide. About 13% of the adult Japanese population is estimated to have CKD [1]. However, the general population including non-health care professionals and patients have little understanding and low awareness of CKD [2]. Therefore, active provision of information about risk factors for progression of CKD and related complications such as obesity and smoking is important [3]. Ambulatory educational programs reduce CKD progression, decrease the incidence of dialysis, and reduce mortality in patients with CKD [4, 5]. Moreover, the frequency, * Tsutomu Sakurada sakurada@marianna‑u.ac.jp 1
Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2‑16‑1 Sugao, Miyamae‑ku, Kawasaki, Kanagawa 216‑8511, Japan
duration, and cost of hospitalization within 6 months after the start of dialysis are reduced by such programs [6]. However, an ambulatory education program requires frequent visits. In addition, peer support from patients with dialysis or transplantation, screening for all the complications of CKD such as cardiovascular diseases, and giving guidance from medical staff within a limited time
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