Preemptive assessment of self-care ability increases choice for peritoneal dialysis in patients with kidney failure

BACKGROUND: Peritoneal dialysis (PD) relies on the patients' efforts to conduct the procedure at home. Uncertainty about their ability to perform PD tasks may deter patients from choosing this modality. We conducted a randomized controlled trial to investigate the impact of preemptive evaluation of self-care PD ability on changing PD uptake. METHODS: End-stage kidney disease (ESKD) patients approaching dialysis with no definite contraindications for PD were recruited and randomized to control or intervention group. Both groups received kidney replacement therapy (KRT)-targeted education using a shared decision-making approach. Patients in the intervention group underwent additional self-care PD competency assessment, which was conducted by the same team of nephrologists and PD nurses, along with a close family member. Patients were followed until their final dialysis modality was decided or 6 months after enrollment. The primary study outcome was change in PD choice. RESULTS: A total of 263 patients were recruited and followed for 45 (IQR: 33-51) days. A significant higher rate of PD selection was demonstrated in the intervention group compared with the control group (54.6% [95% CI: 45.7%-63.4%] vs. 38.3% [95% CI: 30.1%-47.2%], P=0.008; risk difference = 16.3%, 95% CI: 4.4%-28.2%, P=0.007) in the intention-to-treat analysis. Multivariable logistic analysis revealed that preemptive self-care PD competency assessment (Odds ratio [OR]=2.04, 95% CI: 1.19-3.50, P=0.010), prior knowledge of KRT (OR=2.09, 95% CI: 1.13-3.89, P=0.021) and higher education level (OR=3.11, 95% CI: 1.18-8.16, P=0.021, ref: illiterate/primary school) were independent determinants associated with an increased likelihood of PD choice. There was no significant difference in the assessment results of self-care PD ability between patients who chose PD and those who selected hemodialysis. CONCLUSIONS: Preemptive assessment of self-care PD ability, which provides advance information on the feasibility of independent PD or the need for assisted PD, significantly increases PD selection among ESKD patients.