Abstract
BackgroundPeritoneal dialysis (PD) is a home-based therapy performed by patients or their relatives in numerous cases, and the role of patients’ educational practices in the risk of peritonitis is not well assessed. Our aim was to evaluate the effect of PD learning methods on the risk of peritonitis.MethodsThis was a retrospective multicentric study based on data from a French registry. All incident adults assisted by family or autonomous for PD exchanges in France between 2012 and 2015 were included. The event of interest was the occurrence of peritonitis. Cox and hurdle regression models were used for statistical analysis to asses for the survival free of peritonitis, and the risk of first and subsequent peritonitis.Results1035 patients were included. 967 (93%) received education from a specialized nurse. Written support was used for the PD learning in 907 (87%) patients, audio support in 221 (21%) patients, and an evaluation grid was used to assess the comprehension in 625 (60%) patients. In the “zero” part of the hurdle model, the use of a written support and starting PD learning with hands-on training alone were associated with a lower survival free of peritonitis (respectively HR 1.59, 95%CI 1.01–2.5 and HR 1.94, 95%CI 1.08–3.49), whereas in the “count” part, the use of an audio support and starting of PD learning with hands-on training in combination with theory were associated with a lower risk of presenting further episodes of peritonitis after a first episode (respectively HR 0.55, 95%CI 0.31–0.98 and HR 0.57, 95%CI 0.33–0.96).ConclusionsThe various PD education modalities were associated with differences in the risk of peritonitis. Prospective randomized trials are necessary to confirm causal effect. Caregivers should assess the patient’s preferred learning style and their literacy level and adjust the PD learning method to each individual.
Highlights
Peritoneal dialysis (PD) is a home-based therapy performed by patients or their relatives in numerous cases, and the role of patients’ educational practices in the risk of peritonitis is not well assessed
It is well demonstrated that peritoneal dialysis (PD) delivers a high-quality treatment to patients presenting with end-stage renal disease
The survival of patients treated by PD is equivalent to the survival of those treated by hemodialysis, and several authors have shown that the technique is well tolerated and cost effective [1,2,3]
Summary
Peritoneal dialysis (PD) is a home-based therapy performed by patients or their relatives in numerous cases, and the role of patients’ educational practices in the risk of peritonitis is not well assessed. Our aim was to evaluate the effect of PD learning methods on the risk of peritonitis. The rate of peritonitis is highly variable worldwide, and within countries [7,8,9]. It is important to accurately analyze the effect of modifiable factors, since they are the most relevant to decreasing the rate of peritonitis [12]. There is a lack of data regarding the role of patients’ educational practices in the peritonitis risk [13]. The objective of our study was to describe the educational practices proposed to French patients treated by PD and to evaluate the effect of these currently applied educational practices on the risk of peritonitis
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