|
|
|
          
|
4.2 Preparation for Renal Replacement Therapy (RRT) 4.2.3 Education, Counselling and Informed Choice of Modality Education and counselling can be very beneficial in patients whose entry into RRT is 'planned'. Most renal centres approach this in a multidisciplinary fashion aiming to allow patients to come to terms with, and to understand the medical aspects of their disease and also to allow them to make an informed choice of modality. Patients often learn as much from fellow patients within a supportive group as they do from staff members. In addition, patients can be made aware of the wide range of educational material available, much of it having been written specifically for the dialysis patient. The main dialysis modalities, HD and PD are complementary. Automated peritoneal dialysis (APD) has provided a welcome extension of choice. Patients appropriately appraised of medical and psychosocial constraints should be involved in the choice of their own treatment modality. Limited options for vascular access mitigate against the choice of haemodialysis. The elderly, diabetics (provided retinopathy is controlled) and patients with all but the most severe forms of cardiovascular compromise do at least as well on haemodialysis as on CAPD. Haemodialysis is perhaps the better initial option in patients of above average size in whom CAPD may not provide adequate treatment when their residual function has been lost. On the other hand, PD generally provides more independence and freedom of movement particularly for international travel. APD may offer more powerful dialysis than CAPD and may therefore allow patients to remain on PD longer when natural renal function fails. The choice of initial modality is as important to patients as is the flexibility to change from one treatment to another according to preference or if medical complications supervene. This requires unimpeded access to all the therapies.  |