TOPLINE

A retrospective study found that more than 60% of patients with chronic kidney disease (CKD) stages 4 and 5 who received structured predialysis education chose peritoneal dialysis (PD), with over half ultimately starting this home-based treatment.

METHODOLOGY

• Researchers conducted a retrospective study to assess the effect of predialysis education on the choice of renal replacement therapy among patients with CKD stages 4 and 5.
• They analysed 118 patients (mean age, 54.3 years; 34% women) who received individualised predialysis education at a large renal centre in Warsaw, Poland (2020-2023).
• Patients attended sessions lasting about 1.5-2.0 hours, delivered by a team of two nurses and two physicians. The educational programme covered both theoretical and practical aspects of PD, in-centre haemodialysis (HD), and kidney transplantation, conducted using visual materials, informational brochures, and hands-on demonstrations with dialysis equipment.
• Patients were assessed for contraindications to PD and categorised into the following groups: those with no contraindications, those with relative contraindications, those requiring assisted PD, or those with absolute contraindications.
• Analysis examined factors — including age, sex, causes of kidney failure, laboratory results, lifestyle, living conditions, functional status, support from relatives, presence of hernias, and postoperative scars — that influenced the choice of dialysis modality.

TAKEAWAY

• According to the physicians and nurses at the centre, 75 (63.5%) patients had no medical or psychosocial barriers to PD; 17 (14.4%) had relative contraindications; 19 (16.1%) required assisted dialysis; and seven (6.0%) were disqualified from PD.
• After the educational programme, 74 (62.7%) patients chose PD, and 44 (37.3%) patients opted for HD. Of those who chose PD, 61 (52% of all patients) started PD, whereas the rest of the patients received a transplant (3.5%), remained in predialysis care (4.0%), or discontinued PD due to complications (3.5%).
• Women were somewhat more likely than men to choose PD, but this difference was not statistically significant; occupational activity and retirement status showed no significant association with the choice of modality, and most patients (91.5%) reported suitable home conditions for the therapy.
• Factors that were significantly associated with a reduced likelihood of choosing PD were advanced age (odds ratio [OR], 0.967; P = .010), diabetes (OR, 0.353; P = .008), high BMI (OR, 0.884; P = .010), previous abdominal surgical scars (OR, 0.423; P = .029), and the need for assisted PD (OR, 0.264; P = .013).

IN PRACTICE

"Pre-dialysis education plays a crucial role in enabling patients to actively participate in the selection of an appropriate renal replacement therapy modality," the authors wrote.

SOURCE

This study was led by Magdalena Mosakowska, MD, Military Institute of Medicine - National Research Institute, Warsaw, Poland. It was published online on June 27, 2026, in BMC Nephrology.

LIMITATIONS

The study was limited by its small sample size, the retrospective design, the potential selection bias, and the absence of a control group. Additionally, the uniformity of the educational intervention was not formally validated, and patient-reported experience measures were not assessed. The study did not separately analyse patients subsequently referred for kidney transplantation.

DISCLOSURES

The study did not report any specific funding. One author reported receiving personal fees from Baxter/Vantive for speaking engagements, unrelated to this work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.