title: Analysis of patient flow into dialysis: role of education in choice of dialysis modality.
abstract: BACKGROUND
  Despite advances in predialysis care, morbidity and mortality remain high.
  
  
  OBJECTIVE
  To analyze end-stage renal disease (ESRD) patient demographics and clinical data on education on dialysis treatment options, type of chronic renal replacement therapy (RRT), and effects of planned versus non-planned dialysis start.
  
  
  METHODS
  621 patients, from 24 Spanish hospitals, who started RRT in 2002. Peritoneal or vascular access at dialysis initiation was considered "planned."
  
  
  RESULTS
  304 (49%) patients were non-planned and half of them had prior nephrology follow-up. Of the patients with >3 months nephrology follow-up (76% of all), only half were educated on dialysis modalities. Dialysis education was associated with planned start in 73.4% versus 26% in non-educated patients (p < 0.05), shorter follow-up (55 vs 65 months, p = 0.033), more medical visits in the prior year (6.5 vs 4.4, *p < 0.001), more patients starting peritoneal dialysis (31% vs 8.3%*), and more specific follow-up by ESRD unit versus general nephrology care (63% vs 26%*). Non-planned start was associated with older age (63 vs 60.6 years, p = 0.06), fewer medical visits (4.6 vs 6.4*), less education about modality options, and greater use of hemodialysis (92% vs 75%*). Planned patients had better biochemical parameters at start of dialysis.
  
  
  CONCLUSIONS
  Despite nephrology follow-up, half the patients did not have a planned dialysis start. Planned start was associated with better clinical status. More patients chose peritoneal dialysis when educated about dialysis modality options. ESRD-specific units were more likely to provide patient education.
authors.affiliation: Renal Division Baxter, Spain. belen_marron@baxter.com
authors.forename: Belén
authors.initials: B
authors.lastname: Marrón
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Martínez Ocaña
authors.forename: Mercedes
authors.initials: M
authors.lastname: Salgueira
authors.forename: Guillermina
authors.initials: G
authors.lastname: Barril
authors.forename: José M
authors.initials: JM
authors.lastname: Lamas
authors.forename: Marisa
authors.initials: M
authors.lastname: Martín
authors.forename: Tomás
authors.initials: T
authors.lastname: Sierra
authors.forename: Ana
authors.initials: A
authors.lastname: Rodríguez-Carmona
authors.forename: Amparo
authors.initials: A
authors.lastname: Soldevilla
authors.forename: Francisco
authors.initials: F
authors.lastname: Martínez
mesh_terms: D000368:Aged; D002755:Choice Behavior; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009398:Nephrology; D010347:Patient Care Planning; D010353:Patient Education as Topic; D012017:Referral and Consultation; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome