title: Patient education and access of ESRD patients to renal replacement therapies beyond in-center hemodialysis.
abstract: BACKGROUND
  Nephrologists report that patients' choice should play an important role in the selection of renal replacement therapy (RRT) for end-stage renal disease (ESRD). In the United States, kidney transplant rates remain low and <10% of patients utilize home dialysis therapies. This study examined the effect of pre-ESRD processes on the selection of RRT among incident ESRD patients.
  
  
  METHODS
  Using surveys, data were collected for all patients admitted to 229 dialysis units in ESRD Network 18 between April 1, 2002 and May 31, 2002. A total of 1365 patients began chronic dialysis and 1193 facility (87%) and 428 patient (31%) surveys were returned.
  
  
  RESULTS
  Substantial proportions of patients were unaware of their kidney disease (36%) or were not seeing a nephrologist (36%) until <4 months before first dialysis. The presentation of treatment options was delayed (48% either after or < 1 month before the first dialysis). The majority of ESRD patients were not presented with chronic peritoneal dialysis, home hemodialysis, or renal transplantation as options (66%, 88%, and 74%, respectively). Using multivariate analyses, variables significantly associated with selection of chronic peritoneal dialysis as dialysis modality were the probability of chronic peritoneal dialysis being presented as a treatment option and the time spent on patient education.
  
  
  CONCLUSIONS
  An incomplete presentation of treatment options is an important reason for under-utilization of home dialysis therapies and probably delays access to transplantation. Improvements in and reimbursement for pre-ESRD education could provide an equal and timely access for all medically suitable patients to various RRTs.
authors.affiliation: Division of Nephrology and Hypertension, Harbor-UCLA Medical Center, Torrance, California 90502, USA. rmehrotra@labiomed.org
authors.forename: Rajnish
authors.initials: R
authors.lastname: Mehrotra
authors.forename: Douglas
authors.initials: D
authors.lastname: Marsh
authors.forename: Edward
authors.initials: E
authors.lastname: Vonesh
authors.forename: Vickie
authors.initials: V
authors.lastname: Peters
authors.forename: Allen
authors.initials: A
authors.lastname: Nissenson
mesh_terms: D000368:Aged; D003625:Data Collection; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006437:Hemodialysis, Home / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy*; D016030:Kidney Transplantation / Q000523:psychology / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D010530:Peritoneal Dialysis / Q000523:psychology / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D017582:Renal Replacement Therapy / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires