Effect of Multi-Dimensional Education on Disease Progression in Pre-Dialysis Patients in China

Abstract

Background: There is an increasing body of evidence showing that educational interventions aiming at empowering patients are successful in chronic disease management. The aim of this study was to conduct an evaluation of the systematic effectiveness of a multi-dimensional education intervention program in a group of pre-dialysis chronic kidney disease (CKD) patients. In addition, we investigated whether the outcome of the program was related with the amount of education. Methods: We collected data retrospectively from 302 patients with CKD stages 3, 4, and 5, who were followed up from February 2006 to March 2008. The patients were divided into long-time education group and short-time education group depending on the number of provided hours of education. Survival analysis was undertaken to see if the progression of the kidney function differed between these two groups. Results: The percentage of patients receiving long-time education was highest with severe degree of impairment of renal function (45.5%, 61.3%, and 66.7% in CKD stages 3, 4, and 5 groups, respectively). In a multivariate regression analysis, adjusting for age, gender, Charlson comorbidity index, and other traditional risk factors of renal failure, such as smoking, hypertension, and renal function (glomerular filtration rate), the length of time until a decline of renal function by 25% was noted and was significantly shorter in the short-time education group as compared to the long-time education group (p = 0.0334). Conclusion: Multi-component structured empowerment intervention is effective in pre-dialysis CKD patients and may lead to a delay in the progression of kidney disease.

• chronic kidney disease
• education
• kidney disease progression

ACKNOWLEDGMENTS

This study was partly supported by a grant (36-1) from Cheung Kong Scholar Program, Ministry of Education, People’s Republic of China, and by China Scholarship Council (2009601096) and a grant from Beijing Municipal Science and Technology Foundation (09050704310905). The authors thank all the staff in the Division of Nephrology, Peking University Third Hospital. Bengt Lindholm is employed by Baxter Healthcare Corporation. Baxter Novum is the result of a grant to the Karolinska Institute from Baxter Healthcare Corporation.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.