Effect of multidisciplinary pre‐dialysis education in advanced chronic kidney disease: Propensity score matched cohort analysis

Abstract

The mortality and morbidity of end-stage renal failure patients remains high despite recent advances in pre-dialysis care. Previous studies suggesting a positive effect of pre-dialysis education were limited by unmatched comparisons between the recipients and non-recipients of education. The present study aimed to clarify the roles of the multidisciplinary pre-dialysis education (MPE) in chronic kidney disease patients. We performed a retrospective single centre study, enrolling 1218 consecutive pre-dialysis chronic kidney disease patients, between July 2007 and Feb 2008 and followed them up to 30 months. By using propensity score matching, we matched 149 recipient- and non-recipient pairs from 1218 patients. The incidences of renal replacement therapy, mortality, cardiovascular event and infection were compared between recipients and non-recipients of MPE. Renal replacement therapy was initiated in 62 and 64 patients in the recipients and non-recipients, respectively (P > 0.05). The MPE reduced unplanned urgent dialysis (8.7% vs 24.2%, P < 0.001) and shortened hospital days (2.16 vs 5.05 days/patient per year). MPE recipients had a better metabolic status at the time of initiating renal replacement therapy. Although no significant survival advantage from MPE was exhibited, MPE recipients had lower incidence of cardiovascular events (adjusted hazard ratio, 0.24; 95% confidence interval (CI), 0.08 to 0.78; P = 0.017), and a tendency toward a lower infection rate (adjusted hazard ratio, 0.44; 95% CI, 0.17 to 1.11; P = 0.083). MPE was associated with better clinical outcomes in terms of urgent dialysis, cardiovascular events and infection.