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The knowledge of pre-dialysis stage and kidney replacement therapy (KRT) are crucial for chronic kidney disease patients stage 4-5 (CKD G4-5). Nephrologist should actively engage patients and their caregivers in the shared decision-making process to choose the optimal KRT modality. Our survey aimed to evaluate the knowledge of CKD G4-5, chronic hemodialysis (HD) and peritoneal dialysis (PD) patients about the pre-dialysis stage and the 3 KRT modalities.
A prospective survey was conducted from 2022 to 2023 at Cho Ray Hospital (CRH), Ho Chi Minh City (HCMC). We set up a 20-item questionnaire in Vietnamese (5 for pre-dialysis stage, 5 for HD, 5 for PD, and 5 for kidney transplantation (KT)). Each correct answer was scored as 1 point. The questionnaire was validated by 30 freshman medical students, who hadn’t learned Medicine (group a), and 30 post graduated clinicians, who completed the 16 week nephrology training (group b). D-value, a parameter to calculate the item discrimination. D-value = (mean score of group b – mean score of group a)/ standard deviation score of both 2 groups. D value of each question was classified as “easy” if < 0.3, “moderate” if 0.3-0.5 and “difficult” if > 0.5 (Table 1).The questionnaire contained 2 easy, 5 moderate and 13 difficult questions. With the mean D-value of + 0.65, our questionnaire was classified as “difficult”. The estimate time for survey completion was 15 minutes for each patient him/herself. Illiterate patients were excluded. Based on the percentage of correct answers, the knowledge was divided into 3 levels: “good” (greater than 76% correct answers), “moderate” (55-75%) and “poor” (less than 55%). The study was approved by the Ethics Committee of the University of Medicine and Pharmacy at HCMC and CRH.
A printed questionnaire was distributed to 532 patients, in which 214 CKD G4-5 patients, 208 HD and 110 PD patients. The demographic characteristics and outcomes of the study were demonstrated on table 2. Median age was 54, 43.8% male, 89.3% hypertension and 31.8% diabetes. Median eGFR of CKD 4-5 was 6.8 (IQR 4.5-12) ml/min/1.73, mainly CKD G5 (180, 84.1%). Median dialysis time for HD and PD was 24 and 36 months, respectively.
Of 20 questions, the median number of correct answers were 11 (IQR 8-15), in which the PD group achieved the highest score (median 16, IQR 13-17). The PD group was the best among 3 groups with good knowledge about PD and HD, accounting for 94.5% and 74.5%, respectively. The reasons were the PD group mainly experienced HD before starting PD and higher education level than other groups. 29/110 (26.4%) PD patients experienced only PD. The switchovers achieved the highest score (median 17, IQR 14-18). The education level of highschool or above achieved in 46.4% PD, 38% in HD and 14.6% in CKD G4-5 patients (p<0.001). The chronic HD patients obviously had good knowledge in HD (177.85%), but poor knowledge in PD (133, 63.9%). The CKD G4-5 patients was the lowest score group in both predialysis stage and KRT. The knowledge of KT was poor in the CKD G4-5 (161, 65,4%), but good in half of both dialysis groups. As a source of health information, 2/3 patients trusted social media and information sharing from other patients and family members, only 1/3 patients received from healthcare providers.
With the limited awareness in predialysis and KRT of CKD G4-5 and dialysis patients, pre-dialysis education and patient-centered care needs to be comprehensively proceeded to provide integrated in medical care.