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

Figures & data

Table 1. Core curriculums provided to CKD patients.

Section	Courses in eight core curriculums
I	ABC of chronic kidney disease (CKD)
II	How to prevent aggravation of kidney function
III	Life style and CKD
IV	Complications of CKD
V	Medicine, detection, and clinic service of CKD
VI	Self-management and rehabilitation of CKD
VII	Rational diet of CKD
VIII	Replacement treat on CKD

Table 2. Multi-dimensional education intervention about salt intake control.

Component	Content
Knowledge	• Importance of salt intake
	• Salt <3 g every day
Skill	• How to calculate the salt intake
	• Which food is hypersaline? Aginomoto, oyster sauce, soy sauce . . .
	• Seasoning without salt: vinegar, onion, garlic, pepper, mustard . . .
	• Individual serving in dinner
	• Replace 3 g salt by 15 mL soy sauce
	• Less dining in restaurants
Encourage	• Experiences shared by expert patients
	• Questionnaire in salt intake

Table 3. Comparisons of demographic and clinical parameters between pre-dialysis CKD patients receiving more (N = 162) or less (N = 140) formalized education.

	S-MIP (N = 140)	L-MIP (N = 162)	p-Value
Age	65 ± 13	65 ± 12	NS
Sex (female)	50.7% (81)	50% (81)	NS
Diabetes (%)	28.4	24.8	NS
eGFR (mL/min)	38 ± 15	37 ± 16	NS
CKD stage
CKD3	65.0% (91)	46.9% (76)	<0.01
CKD4	20.7% (29)	28.4% (46)	NS
CKD5	14.3% (20)	24.7% (40)	<0.01
Creatinine (mol/L)	219 ± 130	235 ± 121	NS
Height (cm)	163.6 ± 8.2	164 ± 8.4	NS
24h albuminuria (g/day)	1.68 ± 1.83	1.53 ± 1.71	NS
CCI	2.59 ± 1.03	2.65 ± 0.99	NS
Education level	3.38 ± 1.69	3.11 ± 1.81	NS
AHM
ACEI (%)	16.1	15.6	NS
ARB (%)	26.3	26.6	NS
Calcium antagonist (%)	51.8	45.8	NS
β-blocker (%)	27.1	27.3	NS

Note: S-MIP, short-time multi-dimensional education intervention program; L-MIP, long-time multi-dimensional education intervention program; eGFR, estimated glomerular filtration rate; CCI, Charlson comorbidity index; AHM, antihypertensive medication; ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor antagonist; NS, no significant difference between the two groups.

Table 4. Comparisons of clinical parameters between pre-dialysis CKD patients receiving S-MIP (N = 162) or L-MIP (N = 140) formalized education on the baseline and endpoint.

		Baseline			Endpoint
	S-MIP	L-MIP	p-Value	S-MIP	L-MIP	p-Value
BMI (kg/m^2)	24.04 ± 3.65	24.13 ± 3.84	NS	23.59 ± 2.99	24.01 ± 3.14	NS
BP
SBP (mm Hg)	135 ± 16	132 ± 16	NS	131 ± 15	128 ± 15	0.05
DBP (mm Hg)	79 ± 11	78 ± 11	NS	77 ± 10	72 ± 9	0.03
PP (mm Hg)	55 ± 15	54 ± 17	NS	55 ± 15	54 ± 14	NS
BW (kg)	64.9 ± 12.3	64.8 ± 12.6	NS	65.6 ± 12.9	65.1 ± 11.9	NS
Hb (g/L)	116.5 ± 20.5	116.7 ± 27.2	NS	115.6 ± 21.2	119.2 ± 26.6	0.03
sALB (g/L)	42.8 ± 3.52	42.6 ± 3.66	NS	40.9 ± 4.01	43.3 ± 3.78	0.04
DP (g/kg/day)	0.76 ± 0.21	0.78 ± 0.20	NS	0.74 ± 0.18	0.68 ± 0.15	0.02
Life style
AHM (%)	80	78	NS	74	72	NS
LPI (%)	56	59	NS	60	73	<0.001
Smoking	16.8% (21)	12.2% (20)	NS	12.8% (15)	3.1% (5)	0.01
Drinking wine	10.9% (15)	6.1% (10)	NS	4.2% (8)	0.5% (1)	<0.001

Note: S-MIP, short-time multi-dimensional education intervention program; L-MIP, long-time multi-dimensional education intervention program; BMI, body mass index; BW, body weight; SBP, systolic blood pressure; DBP, diastolic blood pressure; PP, pulse pressure; Hb, hemoglobin; sALB, serum albumin level; DPI, dietary protein intake (n = 102); AHM, anti-hypertension medicine; LPI, low protein intake; NS, no significant difference between the two groups.

Table 5. Multivariate regression model predicting time to significant renal function decline: decrease by 25% or initiation of dialysis in pre-dialysis patients.

Parameter	Parameter estimate	Standard error	p-Value
Intercept	147.41	53.92	0.006
Age (years)	0.17	0.59	0.771
Gender (female)	5.99	9.11	0.517
CKD multi-education	106.60	16.78	<0.001
CCI	26.37	8.86	0.003
Smoking	33.18	24.93	0.184
Hypertension, presence	6.92	16.69	0.679
BMI	−15.23	10.68	0.155
eGFR (MDRD China)	3.04	0.56	<0.001

Notes: The adjusted R² of the model is 0.25. CKD, chronic kidney disease; BMI, body mass index; CCI, Charlson comorbidity index; BMI, body mass index; eGFR, estimated glomerular filtration rate.

Figure 1. Survival of kidney function in long-time education group (L-MIP) and short-time education group (S-MIP).