| Theme | Informed Consent and Preparation on Renal Replacement Therapy for Patients with End Stage Renal Disease | |
|---|---|---|
| Title | Shared decision-making in the appropriate peritoneal dialysis initiation | |
| Publish Date | 2009/11 | |
| Author | Sonoo Mizuiri | Kidney Center, Toho University Omori Medical Center |
| Author | Ken Sakai | Kidney Center, Toho University Omori Medical Center |
| Author | Yasushi Ohashi | Kidney Center, Toho University Omori Medical Center |
| [ Summary ] | In relation to the choice of modality for renal replacement therapy, patients with chronic renal failure should receive properly timed education before their levels reach GFR<30 ml/min. This should be concerned with options for possible treatments, including hemodialysis, peritoneal dialyis and renal transplantation. Decisions should be made in relation to informed consent. Education for patients and timing of planned treatment initiation are essential to confer maximum benefits from the selection of peritoneal dialysis. The key points related to informed consent and patient education are that: 1) benefits of CAPD are associated with better survival rates than HD only during the 1-2 years when there is preserved residual renal funcioning, 2) treatment modality may need to be switched to hemodialysis or renal transplantation when the peritoneal membrane becomes inadequate for treatment and the fact that 3) CAPD is a "self-care" form of dialysis performed at home, with the success of treatment largely depending on the patient's ability to carry out the procedure. Changes in modality for renal replacement therapy are available through the treatment period. Remaining kidney function is the most important factor affecting survial rates for dailysis patients. A "PD first" policy is advocated to improve the quality of life for dialysis patients who have some preserved residual renal function. | |