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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 4  |  Page : 636-640
Effect of an educational program on awareness about peritoneal dialysis among patients on hemodialysis


1 Urmia University of Medical Sciences, Urmia, Iran
2 Imam Khomeini Training Hospital, Urmia, Iran
3 Tehran University of Medical Sciences, Tehran, Iran
4 Iran University of Medical Sciences, Tehran, Iran

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Date of Web Publication26-Jun-2010
 

   Abstract 

Several years after the initial usage of continuous ambulatory peritoneal dialysis (CAPD), the percentage of patients using this continues to be very low constituting about 15% of all patients with end-stage renal disease (ESRD). In this study, we attempt to define the impact of an educational program for improving the use of CAPD. This is a quasi-experimental study (before-after) conducted with educational materials including workshop, teaching by booklet and showing educational films, performed in Urmia, Iran. We designed a questionnaire for data col­lection and enrolled 160 patients with an aim-based sampling method. We used descriptive sta­tistics and Friedman test for analysis in SPSS software version 11.5. The overall patients' infor­mation about CAPD defined by total scoring was as follows: 75% had little information; 19% had moderate information and 6% of patients were well informed. All the information levels increased after intervention. Our study suggests that the poor utilization of CAPD is due to relative un­awareness about PD and/or lack of adequate facilities.

How to cite this article:
Ghafari A, Sepehrvand N, Hatami S, Ahmadnejad E, Ayubian B, Maghsudi R, Kargar C. Effect of an educational program on awareness about peritoneal dialysis among patients on hemodialysis. Saudi J Kidney Dis Transpl 2010;21:636-40

How to cite this URL:
Ghafari A, Sepehrvand N, Hatami S, Ahmadnejad E, Ayubian B, Maghsudi R, Kargar C. Effect of an educational program on awareness about peritoneal dialysis among patients on hemodialysis. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2014 Aug 31];21:636-40. Available from: http://www.sjkdt.org/text.asp?2010/21/4/636/64619

   Introduction Top


Progressive increase in the number of patients with end-stage renal disease (ESRD) is a noti­ceable problem in modern medicine. The re­ported incidence of ESRD is 268 per million population (pmp) per year, in 1996 in the United States. [1] The population of patients with ESRD amounts to about 30,000 in Iran, of whom almost 15,000 are on dialysis and the remaining, are transplant recipients. Although peritoneal dia­lysis (PD) was introduced in Iran in 1996, only four percent of ESRD patients are currently on treatment with PD. [2] Patients with ESRD re­quire some kind of renal replacement therapy for survival in the form of renal transplantation or dialysis (hemodialysis or PD). Deciding about which of these options is best suited to an individual patient depends on his/her residual renal function and imparting suitable educa­tion to the patient about the modalities avai­lable, thus making it easier to the patient and the treating doctor in making a decision about the mode of replacement therapy, which would provide maximum benefit and the best quality of life to the patient. Although renal transplan­tation is the ideal renal replacement therapy, most of the time, it is not feasible and dialysis becomes inevitable. [3]

Peritoneal dialysis (PD) offers the following advantages over hemodialysis (HD): no need for heparin therapy, no need for vascular ac­cess, patient's vascularity is kept intact, there is gradual filtration of blood, hemodynamic and metabolic stability is maintained, there is be­tter control of blood pressure, complications due to frequent blood transfusion such as viral hepatitis are low, and lower costs (personal or governmental expenditure to provide the re­quired facilities or dialysis machines).

Also, the possibility to perform dialysis by himself/herself at home, without any depen­dence on hospital, which results is gaining more self confidence, are some other advan­tages of PD. Despite all these advantages, long­term persistent involvement in dialysis during the day, peritonitis, missing opportunity to com­municate with others (patients, nurses), proba­ble isolation, high risk for protein malnutrition especially in abandoned elderly patients are some problems and disadvantages of PD. [4],[5],[6]

Considering the increase in the number of ESRD patients, financial aspects should be borne in mind while deciding about the va­rious therapeutic options. There are costs rela­ted to purchase and maintenance of HD ma­chines. On the other hand, requirement of a se­parate outpatient clinic, a few dedicated nurses and the need for an educational program, are some expenditure unique to PD. [1]

In a study in Belgium, the mean real cost of HD for each patient, was 1.13 million Belgium Franks (BF) per year, which included cost of personnel, machines and disposables such as membrane, filter, tube and dialysate fluid. How­ever, the cost of PD was approximately 702,520 BF a year, which included the dialysate liquid and nursing team. Lower requirement of ery­thropoietin (EPO) in PD patients compared with HD saves about 2,08,000 BF per patient per year. [7]

Utilization of PD has been reported to be very low worldwide, and with some variations, in­cludes approximately 15% of ESRD patients. [7] There are about 3000 patients on PD in Iran, which forms 8% of Asian dialysis population. [2],[8]

More recently, in most of the Western coun­tries, the number of patients on PD is growing in a rapid manner; however, despite many de­cades since PD was first introduced, it has not been able to establish its own place, yet. [9] Utilization of PD in Urmia began in 1999, and we currently have 24 patients on this modality of renal replacement therapy.

This study was conducted to study and eva­luate the effect of PD educational programs on increasing knowledge of ESRD patients about the use of CAPD.


   Materials and Methods Top


The study design was quasi-experimental and before-after, conducted on patients on HD. The sampling was aim-based and all patients on HD (n=160) were enrolled. The intervention was a PD educational program which included edu­cational films, brochures and booklets on CAPD, which were supplied by the research group to the subjects of study.

We designed a questionnaire as pre-test and post-test to investigate the effect of this inter­vention. To evaluate the questionnaire's vali­dity, we first tested it in five patients and sub­sequently, the queries were adjusted.

The designated questionnaire had two parts: the first part consisted of patient's demogra­phic information and included four questions pertaining to determination of the socioeco­nomic status of the patient. The second part of the questionnaire evaluated the knowledge of patient about PD. The number of correct answers to each question determined the knowledge status about PD. Knowledge was categorized into three levels; low, moderate and high. Sub­jects with a knowledge score of 0-33 were con­sidered as low, 34-66 was considered as mo­derate, and more than 67 was considered as high. Queries were encoded and fulfilled be­fore, and a day after the education.

We used descriptive statistics and Friedman test in SPSS software version 11.5. P < 0.05 was considered significant.


   Results Top


Among the 160 HD patients studied, 73 were females (45.6%) and 87 were males (54.4%). Twenty-one patients (13.1%) were younger than 35 years, 100 (68.8%) were 35-70 years old and 29 (18.1%) were older than 70 years.

We assessed the knowledge of subjects cove­ring the following areas:

  1. How to perform a peritoneal dialysis (before and after education):

    Before: 117 (73.1%) had little information, 23 (14.4%) were moderate and 20 (12.5%) were well informed.

    After: 80 (50%) had little information, 54 (33.8%) were moderate and 26 (16.3%) were well informed.
  2. Knowledge about equipments required for PD: Before: 113 (70%) had little information, 30 (18.8%) were moderate and 18 (11.3%) were well informed.After: 77 (48.1%) had little information, 59 (36.9%) were moderate and 24 (15%) were well informed.
  3. Knowledge about advantages and disad­vantages of PD:

    Before: 134 (83.8%) had little information, 18 (11.3%) were moderate and eight (5%) were well informed.

    After: 103 (64.4%) had little information, 42 (26.3%) were moderate and 15 (9.4%) were well informed.
  4. General knowledge of HD patients about PD:

    Before: 126 (78.8%) had little information, 17 (10.6%) were moderate and 17 (10.6%) were well informed.

    After: 100 (62.4%) had little information, 38 (23.8%) were moderate, and 22 (13.8%) were well informed.


Knowledge status among males and females was evaluated before and after education and the results are shown in [Table 1]. Friedman ana­lysis was used to determine whether the in­fluence of gender on knowledge status is signi­ficant or not. The comparison of knowledge about PD, before and after education, among the two gender groups was significant (P = 0.000).

The knowledge status, before and after edu­cation, in different age-groups is shown in [Table 2]. Relationship between age and know­ledge status was significant in all three age­groups; younger than 35 years (P = 0.000), 35­70 years (P = 0.000) and > 70 years group (P = 0.04).

The knowledge status about PD in groups with different literacy levels is shown in [Table 3]. According to Friedman analysis, correlation between knowledge status and literacy level was significant in all three groups (in low literacy group, P = 0.000 and in high literacy group, P = 0.046).

The knowledge status about PD, before and after education, in groups with different socio­economical conditions is shown in [Table 4].

According to Friedman analysis, the relation­ship was significant in all three groups (in groups with low and average income, P = 0.000, and in those with high-income, P = 0.002).


   Discussion Top


Selecting a kind of replacement therapy for ESRD patients requires a precise informed de­cision-making by the patient and physician and should consider maximum advantages and mi­nimum disadvantages. Having appropriate and adequate knowledge enables patients who are to be started on dialysis treatment, to choose a therapy according to their own preferences and compatible with their life conditions. [10]

In a study by Gomez et al, the standard in­formation package, used as a patient education program, effectively resulted in patients having a significantly improved level of knowledge and understanding of ESRD and the different treat­ment options available. [11]

Other studies reveal that PD offers some ad­vantages for the increasing number of elderly patients with ESRD such as hemodynamic sta­bility, steady state metabolic control, good con­trol of hypertension, independence from hos­pital visits and avoidance of repeated vascular accesses thereby improving the quality of life in all age-groups. [5]

In a study by Juergensen et al, education re­sults in an improvement in compliance of pa­tients for dialysis. It was noted that more than half of the patients had a compliance rate (CR) < 95%; after the education, 83% of 42 patients, had a CR >/= 95%. [12]

Despite early beginning of PD in Iran in 1996, the number of patients who are utilizing this modality of RRT is very low compared with other countries. [7]

The reason could be due to the following two groups of factors:

  1. Patient factors: economical, social, cultural and health condition, knowledge about the­ rapeutic modalities available and their me­ thods of performance as well as the back­ ground disease.
  2. Factors related to the medical system in­ cluding medical staff (nephrologists and nursing) and knowledge of this group and supporting systems about peritoneal dialysis.


The results of this study show that the know­ledge of HD patients about required equip­ments, method of performance and advantages and disadvantages of PD is very low and this improved significantly after imparting the edu­cational program.

In general, educational interventions for en­hancing knowledge of patients or medical staff could be effective in the development of PD. We suggest a similar study to increase know­ledge among medical staff about PD. A perma­nent educational program for HD patients in all HD departments of the country is recom­mended, because the benefit of education is undeniable.


   Acknowledgement Top


The authors would like to thank Urmia Uni­versity of Medical sciences for the grants pro­vided for our study.

 
   References Top

1.van Biesen W, Vanholder R, Lameire N. The role of peritoneal dialysis as the first-line renal replacement modality. Perit Dial Int 2000; 20(4):375-83.  Back to cited text no. 1      
2.Pendse SS, Ajay S. Approach to patients with chronic kidney disease, Stage 1-4. In: Dau­girdas JT, Blake PG, Ing TS, eds. Handbook of dialysis Fourth Edition. Philadelphia: Lippincott Williams & Wilkins. 2006:7.  Back to cited text no. 2      
3.Singh AK, Brenner BM. Dialysis in the Treat­ment of Renal Failure. In: Kasper DL, Braun­wald E, Fauci AS, et al., eds. Harrison's Principles of Internal Medicine. 16th ed. New York: McGraw-Hill 2005:1663-7.  Back to cited text no. 3      
4.Blake PG. Peritoneal dialysis in Asia: an external perspective. Perit Dial Int 2002;22(2): 258-64.  Back to cited text no. 4      
5.Dimkovic N, Oreopoulos DG. Chronic perito­neal dialysis in the elderly. Semin Dial 2002; 15(2):94-7.  Back to cited text no. 5      
6.Heaf JG, Ltkkegaard H, Madsen M. Initial sur­vival advantage of peritoneal dialysis relative to haemodialysis. Nephrol Dial Transplant 2002;17(1):112-7.  Back to cited text no. 6      
7.Wuerth DB, Finkelstein SH, Schwetz O, Carey H, Kliger AS, Finkelstein FO. Patients' des­criptions of specific factors leading to modality selection of chronic peritoneal dialysis or hemodialysis. Perit Dial Int 2002;22(2):184-90.  Back to cited text no. 7      
8.Lo WK. What factors contribute to differences in the practice of peritoneal dialysis between Asian countries and the West? Perit Dial Int 2002;22(2):249-57.  Back to cited text no. 8      
9.Blake PG. Economics, focus on pre-dialysis may help stabilize peritoneal dialysis in Canada. Nephrol News Issues 2002;16(5):56-8.  Back to cited text no. 9      
10.Castro MJ, Celadilla O, Munoz I, et al. Home training experience in peritoneal dialysis patients. EDTNA ERCA J 2002;28(1):36-9.  Back to cited text no. 10      
11.Gomez CG, Valido P, Celadilla O, Bernaldo de Quiros AG, Mojon M. Validity of a standard information protocol provided to end-stage renal disease patients and its effect on treat­ment selection. Perit Dial Int 1999;19(5):471-7.  Back to cited text no. 11      
12.Juergensen PH, Gorban-Brennan N, Finkelstein FO. Compliance with the dialysis regimen in chronic peritoneal dialysis patients: utility of the pro card and impact of patient education. Adv Perit Dial 2004;20:90-2.  Back to cited text no. 12  [PUBMED]    

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Correspondence Address:
Nariman Sepehrvand
Students' Research Committee, Urmia University of Medical Sciences, Urmia, West-Azerbaijan
Iran
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    Abstract
    Introduction
    Materials and Me...
    Results
    Discussion
    Acknowledgement
    References
    Article Tables
 

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