Multidisciplinary predialysis education reduced the inpatient and total medical costs of the first 6 months of dialysis in incident hemodialysis patients.
BACKGROUND
The 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.


METHODS
We 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.


RESULTS
The 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.


CONCLUSIONS
Participation 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.


BACKGROUND
ClinicalTrials.gov NCT00644046.
Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
Yu-Jen
YJ
Yu
Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
I-Wen
IW
Wu
Laboratory for Epidemiology, Department of Health Care Management, Chang Gung University, Tao-Yuan, Taiwan.
Chun-Yu
CY
Huang
Laboratory for Epidemiology, Department of Health Care Management, Chang Gung University, Tao-Yuan, Taiwan.
Kuang-Hung
KH
Hsu
Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
Chin-Chan
CC
Lee
Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
Chio-Yin
CY
Sun
Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
Heng-Jung
HJ
Hsu
Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan; Division of Nephrology, Taipei Medical University Hospital, Taipei, Taiwan; School of Medicine, Taipei Medical University, Taipei, Taiwan.
Mai-Szu
MS
Wu
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007297:Inpatients; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000473:pathology; D007902:Length of Stay / Q000191:economics; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D015397:Program Evaluation; D011446:Prospective Studies; D006435:Renal Dialysis / Q000191:economics*; D013997:Time Factors; D055815:Young Adult