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Peritoneal dialysis is done at home. Haemodialysis is done at least three times a week and lasts for four to five hours. It can also be done overnight. During haemodialysis, needles are used to access your blood.

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Your blood is taken through a special filter called a dialyser, which cleans the blood. It is then returned clean to your body. Currently, in Australia, nearly 25 per cent of people on dialysis are using this method. About 40 per cent of new patients choose peritoneal dialysis early in their journey with end stage kidney disease. There are two types of peritoneal dialysis: continuous ambulatory peritoneal dialysis the day-time bags and automated peritoneal dialysis the overnight machine.

Both use the same catheter tube , which is placed in the stomach. After the MDM, a specialised pre-dialysis nurse provides education tailored to the patient's profile. All patients receive general renal replacement information. If the patient's profile includes transplantation, they receive information from a transplant nurse. If it includes PD, they receive information from a PD nurse. CHD is discussed briefly, and is only further explained if the patient does not choose PD.

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Furthermore, the training that the patient and if possible, the partner or other family members receives before the start of home dialysis is discussed. If there are no family members who are willing or able to contribute, passive HHD or passive PD with the help of home care is discussed. If the profile only includes CHD, no information is provided on other modalities. The education is provided in a single session, which is repeated if the patient wishes. Written brochures and educational videos are also provided. Meetings with other patients are offered and arranged if requested by the patient or their family.

The patient's response to this educational session is discussed in a second MDM.

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Following the second MDM, the patient and nephrologist choose a treatment modality during the next visit to the outpatient clinic. This retrospective observational file research study examined all patients that received a treatment recommendation in the GUIDE programme between 12 September and 18 December at Meander Medical Centre. This includes all patients that started preparation for dialysis or transplantation, as well as all patients that were registered during this period because of their choice for conservative treatment.

Patient characteristics gender, age, BMI, educational level, primary cause of renal disease [ 20 ] and Charlson comorbidity index [ 21 , 22 ] were collected by means of record investigation and analysis of the questionnaires filled out during the GUIDE process.

The outcome of each step was compared with the patients' previous steps. Information on the modality distribution before the implementation of GUIDE was collected through analysis of the hospital's registry on patients who started dialysis. The period of May to August 16 months, the same duration as the research period was chosen to compare with the research period. Patient characteristics are presented as mean and SD for normally distributed continuous variables and as median, interquartile range IQR , minimum and maximum for abnormally distributed variables.

The distribution of patients between the treatment modalities or between grouped variables is presented as the number of patients and percentage of the total. The patient characteristics, timeline and eGFR values of the group that chose home dialysis were compared with those of the group that chose in-centre dialysis. For normally distributed continuous variables e. For nominal variables e. Their mean age was When comparing the patients that chose home dialysis with those that chose in-centre dialysis, no significant differences were found in patient characteristics.

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Patient characteristics. The median time between the start of the process and the treatment choice was 8 weeks, excluding six patients who started the process after starting therapy. The first therapy dialysis or pre-emptive transplantation started after a median of 10 weeks. Between No significant differences were found between the timeline of the patients that chose home dialysis and the timeline of patients that chose in-centre dialysis.

When is dialysis needed?

Nor was there a significant difference in the number of acute patients: During the home visit, Eighty-seven patients received a home visit. The case manager considered home dialysis suitable for Home dialysis was considered unsuitable for For PD was the dialysis modality the nephrologist preferred most frequently, in Conservative treatment was preferred in For 10 patients The case manager's preference was adopted in the MDM in Therefore, the case manager's judgement determined the treatment recommendation in at least For 6 patients, pre-emptive transplantation was recommended, while for 10 patients, conservative treatment was recommended.

For the other 86 patients dialysis was recommended: 54 patients Thirty-two patients Following education provided by a pre-dialysis nurse, In However, 14 patients were advised to have home dialysis but chose in-centre dialysis: 9 of these cases because the patient preferred in-centre dialysis and 5 because of relative contraindications discussed in the MDM that determined the patient's choice.

In total, First therapy. Most of them Therapy switch. At the end of the research period, Forty-two patients At the time, HHD was not yet available at our hospital. During this period, an average of In response to the declining home dialysis rates in the Netherlands, the standardisation and home-focused approach of the GUIDE process, with its home visit, questionnaires, multidisciplinary character and education by a specialised pre-dialysis nurse, aims to optimize the availability and desirability of home dialysis.

Consistent with its objective, the GUIDE programme seems to stimulate the use of home dialysis in a single-centre setting when compared with a historical control group. Of the patients that were advised to have dialysis during the MDM, Of the patients that chose dialysis, At the end of the study, These findings are in line with data from Goovaerts et al.

The case manager plays an important part in the programme, as her conclusions based on the home visit greatly influence the MDM recommendation; her treatment preference determined the MDM recommendation more often than the nephrologist's. In our opinion, the home visit is of great importance to the programme, because it allows someone other than the nephrologist with a long-standing treatment relation to the patient to objectively evaluate the patient's home and social situation. When a patient is referred to GUIDE, the nephrologist only provides information on the course of the information process and avoids recommending a specific treatment modality other than pre-emptive transplantation.

A treatment recommendation or profile is only provided after multidisciplinary discussion. In this way, we aim to help the patient, after completion of the process, choose the best suitable therapy. We found that most patients Further research by means of interviews could clarify the reasons why 14 patients that received a home dialysis recommendation chose in-centre dialysis.

If their decision was caused by fear or lack of knowledge, this may be prevented in the future by further improvement of the education provided. A total of There was a at least in part temporary loss of three HHD patients, which could be prevented in the future by enhancing the capacity of HHD training. In contrast to the common belief that an acute start of dialysis leads to more use and continuation of in-centre dialysis, we found no significant difference in the number of acute patients between the group that chose home dialysis and the group that chose in-centre dialysis, even though some patients that chose home dialysis had to start with in-centre dialysis at first.

Most of the patients The strength of this study is that the study population consists of the entire pre-dialysis population in one hospital within the study period, which makes the distribution among treatment modalities reliable.

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Based on the patient characteristics, the study population seems to represent the average pre-dialysis population in The Netherlands. When compared with European population data about patients at the start of dialysis, the mean age and BMI were somewhat higher in our study respectively, The difference in age can be explained by the fact that our study included mostly older patients that chose conservative treatment. The study is limited by its retrospective nature and by the limited period of follow-up.

Ideally, all patients would have been followed until they started a therapy, chose conservative treatment or died, in order to gain a more reliable distribution of treatments. Furthermore, because the control group was historical, not all variables could be compared. Because this is a relatively small study, no definite statements can be made on subgroups, such as the patients that started the GUIDE process in a period of acute decline of renal function or the patients that chose conservative treatment.

Further research could provide insight into the course of their pre-dialysis process. Moreover, while no significant differences in patient characteristics were found between the patients that chose home dialysis and in-centre dialysis, this could be due to the relatively small number of patients.

To conclude, compared with historical data, the standardised and home-focused pre-dialysis programme GUIDE, with its home visit, seems to successfully increase the number of patients that choose and receive home dialysis. We would like to thank Marion Swager, Ingrid Moraal and Petra van de Linde for their contribution to the construction of the questionnaires and for their constructive advice. We would also like to thank Dr W. Smit, of Jeroen Bosch Hospital, for her advice regarding the medical questionnaire.

Finally, we would like to thank everyone who has contributed to the GUIDE programme at our hospital: the nephrologists, case managers, pre-dialysis nurses, dieticians and secretaries. Oxford University Press is a department of the University of Oxford.

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Associated Data

Volume 9. Article Contents. Materials and methods. Supplementary data.