Mahmud İSLAM, Kenan Evren ÖZTOP

Predialysis education program and early vascular access: a single center experience

Objective: The main objective of this study is to investigate the impact of a pre-dialysis education program on the selection of vascular access during the initiation of maintenance hemodialysis therapy and the short-term impact of this education on patient outcomes. Study Design: A retrospective case control study. Place and Duration of the Study: Ministry of Health Zonguldak State Hospital, Türkiye, between January 1, 2020, and December 31, 2022. Methodology: The data were collected at two different times in the past from patients under maintenance hemodialysis: the first group consisted of a group of patients who received a predialysis education program (intervention group) from a dedicated nephrologist, and the second group included those who did not undergo a control program (control group). Predialysis education program involved six modules addressing understanding kidney disease, diet, and nutrition, treatment options for end-stage kidney disease, dialysis procedures, medication management, and self-care/independence. Patients aged ≥18 years were enrolled in the study. The patients were compared according to their clinical status during the onset of maintenance hemodialysis, including vascular access type, serum potassium level, previous hospitalization, and urgent hemodialysis need. Additionally, the hospitalization and infection rates within 6 months following the onset of maintenance hemodialysis were compared. P<0.05 was assigned as significant. Results: A total of 203 hemodialysis patients; 129 patients in the intervention group and 74 patients in the control group were assessed. Mean ages and gender distribution rates were similar between the two groups (65.06±13.14 vs 65.66±9.13 years, p=0.729, p=0.652, respectively). The control group had more hospitalization (p<0.001), intervention need of vascular access problems (p<0.001), vascular access infection (<0.001), exposure to an intermittent catheter (<0.001), 127 of 129 patients in the intervention group started hemodialysis with an arteriovenous fistula. The control group started hemodialysis with a catheter Potassium, phosphorus, and bicarbonate levels were higher in the control group during the first hemodialysis session (5.25±1.12 vs 4.59±0.79, p<0.001, 6.60±1.18 vs 4.25±1.04, p<0.001, and 21.77±3.96 vs 14.18±2.83, p<0.001, respectively). Conclusion: This study demonstrated that a well-organized education program can lower the burden of morbidity in end-stage kidney disease and support the patient and healthcare providers with a favorable transmission from a non-hemodialysis period to a hemodialysis period.

Keywords:

End-stage kidney disease, Pre-dialysis education, Maintenance hemodialysis Morbidity, Vascular access.,

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