title: Offering Patients Therapy Options in Unplanned Start (OPTiONS): Implementation of an educational program is feasible and effective.
abstract: BACKGROUND
  Patients with unplanned dialysis start (UPS) have worse clinical outcomes than non-UPS patients, and receive peritoneal dialysis (PD) less frequently. In the OPTiONS study of UPS patients, an educational programme (UPS-EP) aiming at improving care of UPS patients by facilitating care pathways and enabling informed choice of dialysis modality was implemented. We here report on impact of UPS-EP on modality choice and clinical outcomes in UPS patients.
  
  
  METHODS
  This non-interventional, prospective, multi-center, observational study included 270 UPS patients from 26 centers in 6 European countries (Austria, Germany, Denmark, France, United Kingdom and Sweden) who prior to inclusion presented acutely, or were being followed by nephrologists but required urgent dialysis commencement by an acutely placed CVC or PD catheter. Effects of UPS-EP on choice and final decision of dialysis therapy and outcomes within 12 months of follow up were analysed.
  
  
  RESULTS
  Among 270 UPS patients who had an unplanned start to dialysis, 214 were able to receive and 203 complete UPS-EP while 56 patients - who were older (p = 0.01) and had higher Charlson comorbidity index (CCI; p < 0.01) - did not receive UPS-EP. Among 177 patients who chose dialysis modality after UPS-EP, 103 (58%) chose PD (but only 86% of them received PD) and 74 (42%) chose HD (95% received HD). Logistic regression analysis showed that diabetes 1.88 (1.05 - 3.37) and receiving UPS-EP, OR = 4.74 (CI, 2.05 - 10.98) predicted receipt of PD. Patients choosing PD had higher CCI (p = 0.01), higher prevalence of congestive heart failure (p < 0.01) and myocardial infarction (p = 0.02), and were more likely in-patients (p = 0.02) or referred from primary care (p = 0.02). One year survival did not differ significantly between PD and HD patients. Peritonitis and bacteraemia rates were better than international guideline standards.
  
  
  CONCLUSIONS
  UPS-EP predicted patient use of PD but 14% of those choosing PD after UPS-EP still did not receive the modality they preferred. Patient survival in patients choosing and/or receiving PD was similar to HD despite age and comorbidity disadvantages of the PD groups.
authors.affiliation: Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, M99, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden. anna.machowska@ki.se.
authors.forename: Anna
authors.initials: A
authors.lastname: Machowska
authors.affiliation: Robert-Bosch-Krankenhaus, Stuttgart, Germany.
authors.forename: Mark Dominik
authors.initials: MD
authors.lastname: Alscher
authors.affiliation: University Hospital of North Staffs, Stoke, UK.
authors.forename: Satyanarayana Reddy
authors.initials: SR
authors.lastname: Vanga
authors.affiliation: Nephrologisches Zentrum, Mettmann, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Koch
authors.affiliation: Odense University Hospital, Odense, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Aarup
authors.affiliation: Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, M99, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden.
authors.forename: Abdul Rashid
authors.initials: AR
authors.lastname: Qureshi
authors.affiliation: Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, M99, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.affiliation: Quintiles, Reading, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Rutherford
mesh_terms: D000066491:Clinical Decision-Making; D003657:Decision Making; D003956:Dialysis; D005060:Europe / Q000453:epidemiology; D005260:Female; D006293:Health Promotion / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000706:statistics & numerical data*; D015995:Prevalence; D006435:Renal Dialysis / Q000401:mortality* / Q000706:statistics & numerical data*; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Acute dialysis; Education; Unplanned start