| Abstract|| |
Despite similar or better patient outcomes, peritoneal dialysis and pre-emptive kidney transplantation are underutilized in Saudi Arabia. Moreover, most patients with end-stage renal disease begin dialysis in unplanned fashion necessitating the commencement of dialysis using central venous catheter access. We aimed to investigate if early patient education can help in overcoming these barriers. The study is a survey-based study at King Abdulaziz Medical City, Riyadh Dialysis Center. In January 2017, we started a monthly Chronic Kidney Disease Education Class in our center. Since then, 14 classes have taken place attended by 54 patients referred from outpatient nephrology clinics with chronic kidney disease (CKD) stages IV and V. The mean age was 51.6 years (16–85); 32 of the attendees were male and 22 were female. The class consisted of a slide informative presentation, a display of educational materials, and interactions with a multidisciplinary team from dialysis, transplantation, vascular access, and dietician services. A feedback survey was given to attendees at the conclusion of the class covering three domains; speakers, the program, and their personal reflections. Feedback options were laid out as “excellent, very good, good, fair, and poor.” All class attendees responded to the questionnaire (100% response rate). The overall class evaluation was positive with the majority of attendees giving “excellent” rating for the speakers and the educational materials covered. Most thought that the class made them understand CKD nature better and helped them choose the right modality of renal replacement therapy. This initiative proves the feasibility of a sustained and attendee-gratifying education class to inform patients with advanced CKD about different options of renal replacement therapy and the need for timely preparation. To objectively measure the class’s effect, the next phase of this review will define the ultimate outcome of each of its attendees.
|How to cite this article:|
Elhassan EA, Al-Ruwaymi M, Osman AI, Al-Sayyari AA. Attendees’ feedback on king abdulaziz medical city pilot chronic kidney disease education class. Saudi J Kidney Dis Transpl 2019;30:440-4
|How to cite this URL:|
Elhassan EA, Al-Ruwaymi M, Osman AI, Al-Sayyari AA. Attendees’ feedback on king abdulaziz medical city pilot chronic kidney disease education class. Saudi J Kidney Dis Transpl [serial online] 2019 [cited 2022 Aug 15];30:440-4. Available from: https://www.sjkdt.org/text.asp?2019/30/2/440/256850
| Introduction|| |
In 2014, most Saudi patients (91%) with endstage renal disease (ESRD) were treated with in-center hemodialysis (HD) while a minority (9%) received peritoneal dialysis (PD). This low rate of utilization of PD is surprising given that PD is less resource-intensive, is associated with similar clinical outcomes, and patients who select PD are more likely to be satisfied with the care they receive. Most Saudi nephrologists believe that PD should be offered to patients as the first dialysis modality. A survey of Saudi ESRD patients undergoing HD suggested that their refusal of PD could be because they had not received proper counseling and education about PD before initiation. Furthermore, the preferred type of chronic HD vascular access is arteriovenous (AV) access rather than HD catheters. HD catheter use has been consistently associated with worse complication and survival rates. The Dialysis Outcomes and Practice Patterns Study international prospective cohort study had shown that Gulf Co-operation Council countries have the lowest use of an arteriovenous (AV) access at HD initiation (19%), whereas most (81%) employed a central venous catheter. Kidney transplantation is the best treatment method for ESRD, with outcomes of pre-emptive transplantation being better than non-pre-emptive kidney transplantation. In King Abdulaziz Medical City (KAMC), a total of 56 kidney transplants were performed in 2017; pre-emptive transplants were 5/56 (9%). Taken together, this information suggests insufficient time and resources to discuss and plan those options for advanced CKD patients. The aim of this multi-disciplinary class is to educate such patients about kidney failure, different options for renal replacement therapy (RRT), and empower them to pursue timely access planning and/or pre-emptive transplantation.
| Subjects and Methods|| |
This is a feedback survey of patients who attended a pilot multi-disciplinary CKD education class at KAMC since its inception in January 2017. An invitation letter to attend the education class was provided to all KAMC outpatient nephrology clinics. Nephrologists seeing patients with stage IV–V CKD handed those letters to patients and encouraged them to attend and bring a family member if they wish. The class took place once a month at KAMC HD Unit. The 2-h session provided education on the normal kidney function, pathophysiological alterations in CKD, information on nutritional and medical treatment for CKD, and options for renal replacement therapy (RRT) in a balanced and unbiased way. The education team comprised a nephrologist, staff physician, dialysis nurses, dietician, vascular, and transplant coordinators. During the round-table session, patients and their family members were informed by a slide-lecture presentation about benefits, complications, and outcomes of different forms of RRTs with emphasis on early choice and access planning [Figure 1]. Brochures, sample catheters, and a PD mannequin were available for demonstration. After the session, all patients received dietary counseling from a dietician and given a complementary snack. Participants were given ample opportunity to ask questions and retain contact information for the PD Unit and the vascular coordinator to assist with their further management. A feedback questionnaire was given to patients in the end, and they were given time to fill it out and return it directly. This was one and a half-page survey which included a few questions in Arabic covering three domains; speakers, the program, and their personal reflections. Feedback options were laid out as “excellent, very good, good, fair, and poor.” All class attendees responded to the questionnaire (100% response rate). Finally, patients were referred back to their primary nephrologists to decide on further course of action.
|Figure 1: A Slide-lecture presentation during the King Abdulaziz Medical City education class.|
Click here to view
| Results|| |
Between January 2017 and May 2018, fourteen classes were carried out. A total of 54 patients received education. Of those, 32 were male and 22 were female. The average age was 51.6 years (range 16–85).
The overall patient responses were positive. Fifty-one (96%) of the respondents rated the speakers as excellent in their ability to deliver the information with clarity, 51 (94.4%) for their ability to interact with, and answer audience questions, and 50 (92.6%) for their ability to lead the conversation effectively.
The presentation’s content, its comprehensiveness and clarity plus simplicity were rated as excellent by 49 (90.7%) and 44 (81.5%), respectively. The level of class organization, multimedia, and educational resources was rated as excellent by 43 (79.6%) and 45 (83.3%), respectively. The duration and time were both highly rated as excellent by 44 (83%) and 42 (77.8%), respectively.
However, the place where the classes took place was rated less than excellent by 14 (26%) [Figure 2].
|Figure 2: Overall attendees' feedback on King Abdulaziz Medical City chronic kidney disease education class.|
Click here to view
Regarding class attendees, all (100%) believed that they were the right candidates to attend, thought the class helped them understand the nature of CKD better, and helped them choose the right modality for them. The overall class evaluation was rated excellent by 50 (92.6%) and very good by four (7.4%) [Figure 3].
|Figure 3: Attendees' personal feedback on King Abdulaziz Medical City chronic kidney disease education class.|
Click here to view
| Discussion|| |
Patients with advanced CKD are often in a state of denial about their disease and are uniformed about kidney failure, RRT, and how their choices could impact on their lives and their families. Physicians have limited time to overcome those barriers during clinic visits or when patients present late in the course of CKD. Informed patients are more likely to choose knowledgeably, pursue timely options, and comply with their treatments than uninformed or misinformed patients.
By the time RRT is needed, many patients receive an urgent, unplanned start. Most of these are initiated with an intravenous catheter and commenced and maintained on HD. A structured, patient-centered education program significantly increased the frequency of PD in patients needing unplanned RRT. A retrospective analysis, using propensity score matching, showed that patients receiving multi-disciplinary pre-dialysis education (compared with those that did not), commenced dialysis at a higher glomerular filtration rate and had reduced need for urgent unplanned dialysis.
Our class aimed to enlighten patients with late stages CKD about the disease, its natural progression and options, including PD, preemptive kidney transplantation, as well HD emphasizing early AV access creation. Challenges initiating the class were getting the administrative and staff interest and collaboration. The renal section was fully supportive to embrace the initiative, secure the place, and make staff available. Given our large outpatient clinic CKD population, we had expected to serve more patients. However, motivating patients and physicians alike to keep utilizing the class by attending and referring was necessary. The results of the post-class survey are encouraging. In its 2nd year, we plan to contact all class attendees to describe the course of their disease and objectively measure the impact of the class on their RRT outcomes.
| Conclusion|| |
KAMC CKD education class had demonstrated the feasibility for a sustained multidisciplinary approach for patients with advanced CKD to assist them in making informed and timely choices prior to starting RRT. Overall patients’ feedback was positive. Next phase of this study will involve contacting class attendees to identify their post-class outcomes.
| Acknowledgment|| |
The authors would like to acknowledge the staff of King Abdulaziz Medical City Peritoneal Dialysis Unit, the unit’s dietician, and the vascular access coordinators for their passionate commitment to organize and maintain this class.
Conflict of interest: None declared.
| References|| |
Dialysis in the Kingdom of Saudi Arabia. Saudi J Kidney Dis Transpl 2015;26:839-48.
Rubin HR, Fink NE, Plantinga LC, Sadler JH, Kliger AS, Powe NR. Patient ratings of dialysis care with peritoneal dialysis vs. hemodialysis. JAMA 2004;291:697-703.
Dahlan R, Qureshi M, Akeely F, Al Sayyari AA. Barriers to peritoneal dialysis in Saudi Arabia: Nephrologists’ perspectives. Perit Dial Int 2016;36:564-6.
Dahlan RA, Alsuwaida AO, Farrash MS, Qureshi MA, Hejaili F, Al Sayyari AA. Let us listen to patients: Underutilization of peritoneal dialysis from patients’ perspectives. Perit Dial Int 2017;37:574-6.
Haddad NJ, Cleef SV, Agarwal AK. Central venous catheters in dialysis: The good, the bad and the ugly. Open Urol Nephrol J 2012:5:12-8.
Pisoni RL, Zepel L, Port FK, Robinson BM. Trends in US vascular access use, patient preferences, and related practices: An update from the US DOPPS practice monitor with international comparisons. Am J Kidney Dis 2015;65:905-15.
Huang Y, Samaniego M. Preemptive kidney transplantation: Has it come of age? Nephrol Ther 2012;8:428-32.
Schanz M, Ketteler M, Heck M, Dippon J, Alscher MD, Kimmel M. Impact of an inhospital patient education program on choice of renal replacement modality in unplanned dialysis initiation. Kidney Blood Press Res 2017;42:865-76.
Cho EJ, Park HC, Yoon HB, et al. Effect of multidisciplinary pre-dialysis education in advanced chronic kidney disease: Propensity score matched cohort analysis. Nephrology (Carlton) 2012;17:472-9.
Elwaleed A Elhassan
Division of Nephrology and Renal Transplantation, King Abdulaziz Medical City, P. O. Box 22490, Riyadh 11426
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3]