The Missouri Kidney Program's Patient Education Program: a 12-year retrospective analysis.

Unbiased patient education for individuals with chronic kidney disease can result in a multitude of positive benefits. The current study reviewed 1,844 participants in a six-topic patient education program over a 12-year period from June 1994 to July 2006, examining patients' level of knowledge about CKD, preferences for treatment, and feelings of hope and fear before and after the educational intervention. After the educational intervention, patients scored significantly higher on knowledge tests of all topics than they scored on the pre-test (p < .05). Overall, there were no significant differences from pre- to post-test on self-ratings of being "scared" or "hopeful," although on the post-test, females were significantly more hopeful than males (p < .01). More patients were interested in peritoneal dialysis as a treatment option after class attendance (p < .001). Multivariate logistic regressions indicated that patients who were older, black, or who had a high school education or less were more likely to prefer center hemodialysis (p < .007). Although overall interest in the transplant option did not change significantly from pre- to post-test, younger patients (52 vs. 67 mean years, p < .001) and males (59% vs. 54%, p = .02) were more interested in receiving a transplant.

How to improve communication in dialysis units: a survey of family focus readers.

Future study of communication between dialysis patients and health care providers could not only aid in understanding the survey findings but also advance emphasis on those areas of care needing to be enhanced. By raising awareness about communication in the dialysis unit, it is hoped that health care professionals will embrace the need to encourage patients to be more involved in the educational and treatment process, enabling them to become active partners in their health care.

The frequency and significance of the "difficult" patient: The nephrology community's perceptions.

Based on casual conversations among those working in dialysis units, dialysis facility staff often face situations created by difficult or disruptive patients, yet relatively little is known about these situations. A computer interactive session at a national meeting in April 2000 was used to gather information on this topic from 203 persons who worked in dialysis facilities. Most respondents viewed situations with such patients as an increasing problem for the nephrology community. Although 71% of the respondents were frequently involved in the attempted resolution of these situations, only 50% indicated that they were adequately trained to intervene. Approximately 38% of the participants' facilities had discharged a patient because of behavioral difficulties in the preceding year. Many facilities lacked policies that could provide guidance to both staff and patients about their rights and responsibilities, as well as policies that specifically addressed difficult/disruptive patient situations. These results highlight the need for increased training for personnel and the development of policies by dialysis units to address this increasingly common problem.

Identification of persons at high risk for kidney disease via targeted screening: the NKF Kidney Early Evaluation Program.

BACKGROUND: More than 340,000 individuals were receiving renal replacement therapy in the United States at the end of 1999; this number is projected to double by the year 2010. Almost half had a primary diagnosis of diabetes mellitus particularly type 2, and more than one quarter a primary diagnosis of hypertension. Studies have demonstrated effective maneuvers to prevent or delay the rate of progression of kidney disease, and decrease morbidity and mortality. The objective of early diagnosis is early detection of asymptomatic disease at a time when intervention has a reasonable potential to have a positive impact on outcome. METHODS: In 1997, the National Kidney Foundation launched KEEP trade mark (Kidney Early Evaluation Program), a free community-based screening that targets first order relatives of persons with hypertension, diabetes or kidney disease, and those with a personal history of diabetes or hypertension. RESULTS: Of the 889 individuals screened in the pilot study, 71.4% had at least one abnormality. The program includes an educational component and referral to a physician for follow-up of abnormal values. CONCLUSIONS: Targeted screenings are an effective means of identifying persons at risk for kidney disease, and can identify individuals at risk early enough in the course of their disease to allow for effective intervention.

Early detection of kidney disease in community settings: the Kidney Early Evaluation Program (KEEP).

BACKGROUND: Early identification of persons at risk for kidney disease provides an opportunity to prevent or delay its progression and decrease morbidity and mortality. Our hypothesis was that implementation of a targeted screening program in communities with high-risk populations would detect previously unidentified persons with or at high risk for chronic kidney disease (CKD) with a prevalence that exceeds that predicted for CKD in the general population. METHODS: Persons with hypertension or diabetes or a first-order relative with hypertension, diabetes, or kidney disease were screened for kidney disease risk factors. Blood pressure, blood glucose level, serum creatinine level, hemoglobin level, microalbuminuria, hematuria, pyuria, body mass index, and estimated glomerular filtration rate (EGFR) were evaluated. RESULTS: Six thousand seventy-one eligible persons were screened from August 2000 through December 2001: of these persons, 68% were women, 43% were African American, 36% were white, 10% were Hispanic, and 5% were Native American. Most reported high-school education or more (84%) and health insurance coverage (86%). Twenty-seven percent met the screening definitions for diabetes; 64%, for hypertension; 29%, for microalbuminuria; 8%, for anemia; 18%, for hematuria; 13%, for pyuria; 5%, for elevated serum creatinine level; 16%, for reduced EGFR; and 44%, for obesity. Among participants without a reported history of specified conditions, screening identified 82 participants (2%) with diabetes, 1,014 participants (35%) with hypertension, 277 participants (5%) with elevated serum creatinine levels, 839 participants (14%) with reduced EGFRs, and 1,712 participants (29%) with microalbuminuria. Thirty-five percent of participants with a history of diabetes had elevated serum glucose levels at screening (> or =180 mg/dL [10 mmol/L]), and 64% with a history of hypertension did not have blood pressure controlled to less than 140/90 mm Hg. Only 18% of participants with a history of diabetes and 31% with a reduced EGFR had blood pressure controlled to less than 130/80 mm Hg and less than 135/85 mm Hg, respectively. CONCLUSION: Targeted screening is effective in identifying persons with previously unidentified or poorly controlled kidney disease risk factors, as well as persons with a moderately decreased EGFR.

Multidisciplinary contributions to rehabilitation: a National Kidney Foundation survey of the dialysis health care team.

Rehabilitation of patients on dialysis encompasses vocational, physical, psychological, and social domains. Rehabilitation efforts in each of these areas require not only a team approach but also performance of specific roles and responsibilities by each member of that team. This National Kidney Foundation survey will show that nephrology professionals do not routinely associate their main professional activities with the rehabilitation of their patients and that all too frequently dialysis patients do not see rehabilitation as within their realm.