Abstract
BackgroundThe multidisciplinary pre-dialysis education (MPE) retards renal progression, reduce incidence of dialysis and mortality of CKD patients. However, the financial benefit of this intervention on patients starting hemodialysis has not yet been evaluated in prospective and randomized trial.MethodsWe studied the medical expenditure and utilization incurred in the first 6 months of dialysis initiation in 425 incident hemodialysis patients who were randomized into MPE and non-MPE groups before reaching end-stage renal disease. The content of the MPE was standardized in accordance with the National Kidney Foundation Dialysis Outcomes Quality Initiative guidelines.ResultsThe mean age of study patients was 63.8±13.2 years, and 221 (49.7%) of them were men. The mean serum creatinine level and estimated glomerular filtration rate was 6.1±4.0 mg/dL and 7.6±2.9 mL⋅min−1⋅1.73 m−2, respectively, at dialysis initiation. MPE patients tended to have lower total medical cost in the first 6 months after hemodialysis initiation (9147.6±0.1 USD/patient vs. 11190.6±0.1 USD/patient, p = 0.003), fewer in numbers [0 (1) vs. 1 (2), p<0.001] and length of hospitalization [0 (15) vs. 8 (27) days, p<0.001], and also lower inpatient cost [0 (2617.4) vs. 1559,4 (5019.6) USD/patient, p<0.001] than non-MPE patients, principally owing to reduced cardiovascular hospitalization and vascular access–related surgeries. The decreased inpatient and total medical cost associated with MPE were independent of patients' demographic characteristics, concomitant disease, baseline biochemistry and use of double-lumen catheter at initiation of hemodialysis.ConclusionsParticipation of multidisciplinary education in pre-dialysis period was independently associated with reduction in the inpatient and total medical expenditures of the first 6 months post-dialysis owing to decreased inpatient service utilization secondary to cardiovascular causes and vascular access–related surgeries.Trial RegistrationClinicalTrials.gov NCT00644046
Highlights
The number of patients worldwide with chronic kidney disease (CKD) and end-stage renal disease (ESRD) being treated with renal replacement therapy has been continuously increasing in recent years, with a 7% rate of increase per year [1]
We hypothesize that knowledge acquisition from multidisciplinary pre-dialysis education (MPE) in the predialysis period may have a ‘‘legacy effect’’ during the postdialysis period. This beneficial effect of MPE may result in differences in disease patterns, reduced medical expenditure and utilization, and reduced medical costs in the immediate postdialysis period. To further clarify this issue, we studied the medical expenditure and utilization incurred during the first 6 months of dialysis initiation in 425 incident hemodialysis patients who were randomized into MPE and non-MPE groups before reaching ESRD
We examined the medical expenditure and utilization incurred in the first 6 months of dialysis initiation in 425 incident hemodialysis patients who were randomized into MPE and non-MPE groups before reaching ESRD
Summary
The number of patients worldwide with chronic kidney disease (CKD) and end-stage renal disease (ESRD) being treated with renal replacement therapy has been continuously increasing in recent years, with a 7% rate of increase per year [1]. Taiwan is the leading country in terms of ESRD prevalence, with a rate of 2447 per million population [3]. The implementation of National Health Insurance (NHI) has helped drive the growth of the ESRD populations in Taiwan [4]. The financial benefit of this intervention has not yet been evaluated in prospective and randomized manner on patients starting hemodialysis. The multidisciplinary pre-dialysis education (MPE) retards renal progression, reduce incidence of dialysis and mortality of CKD patients. The financial benefit of this intervention on patients starting hemodialysis has not yet been evaluated in prospective and randomized trial
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
