Multidisciplinary predialysis education reduces incidence of peritonitis and subsequent death in peritoneal dialysis patients: 5-year cohort study

• Published in: PloS one Vol. 13; no. 8; p. e0202781
• Main Authors: Hsu, Cheng-Kai, Lee, Chin-Chan, Chen, Yih-Ting, Ting, Ming-Kuo, Sun, Chiao-Yin, Chen, Chun-Yu, Hsu, Heng-Jung, Chen, Yung-Chang, Wu, I-Wen
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 23-08-2018; Public Library of Science (PLoS)
• Subjects: Activities of daily living; Adult; Aged; Analysis; Biology and Life Sciences; Cardiovascular disease; Cohort analysis; Cohort Studies; Diabetes; Diabetes mellitus; Dialysis; Education; Effluents; Female; Hazard identification; Health aspects; Hemodialysis patients; Hospitals; Humans; Hypertension; Incidence; Kaplan-Meier Estimate; Kidney diseases; Kidney Failure, Chronic - therapy; Medicine and Health Sciences; Middle Aged; Mortality; Nephrology; Patient education; Patient Education as Topic - methods; Patient outcomes; Patients; People and Places; Peritoneal dialysis; Peritoneal Dialysis - adverse effects; Peritoneum; Peritonitis; Peritonitis - epidemiology; Peritonitis - etiology; Peritonitis - mortality; Prevalence studies (Epidemiology); Prospective Studies; Rank tests; Regression analysis; Retrospective Studies; Risk Factors; Statistical models; Survival; Systematic review; Transplants & implants; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0202781

Technique failure secondary to peritonitis is a grave impediment to remain in peritoneal dialysis (PD) therapy leading to high mortality. Multidisciplinary predialysis education (MPE) has shown improvement in outcomes of chronic kidney disease (CKD) patients. However, the legacy effects of MPE in PD patients remain unclear.
All patients who started PD at single hospital in 2007-16 were enrolled. The incidences of peritonitis and peritonitis-related mortality were compared between MPE recipients and non-recipients. The content of the MPE was standardized in accordance with the NKF/DOQI guidelines. Kaplan-Meier analysis and Cox proportional hazards model were applied to identify the prognostic factors associated with peritonitis-free survival.
Of 398 PD patients, 169 patients had received MPE before starting PD. The patients of MPE group had a lower peritonitis rate [median (IQR) 0 (0.29) versus 0.11 (0.69) episodes/person-year, P< 0.001] and a lower percentage of peritonitis-related deaths (3.6% versus 8.7%, P = 0.04) compared with the non-MPE group. The median time to the first episode of peritonitis in the non-MPE and MPE groups was 33.9 months and 46.7 months, respectively (Cox-Mantel log rank test, P = 0.003). Cox regression analysis revealed that MPE assignment (HR: 0.594; 95% CI: 0.434-0.813, P< 0.001) were significant independent predictors for peritonitis-free survival.
An efficient standardized MPE program may prolong the time to the first episode of peritonitis and reduce peritonitis rate, independent of age, gender, diabetes, hypertension, educational status and PD modality. Subsequently, decreased peritonitis-related death.