Pre-ESRD patient education: a review of the literature.

The education of patients with renal disease focuses on the inevitability of reaching end-stage renal disease (ESRD) and requiring renal replacement therapy. Established education programs begin the process during the late stages of renal disease progression or after the patient reaches ESRD. Uremic symptoms negatively influence the patients' ability to learn and make decisions about their health care. Late referrals to nephrologists and patient educators often occur when the patient is physiologically compromised. Early education for the pre-ESRD patient has the potential to improve the quality of patient satisfaction, delay the onset of dialytic treatment, and increase cost-effectiveness. Despite more than 20 years experience in the treatment of ESRD patients, there are relatively few reports in the literature about early education or pre-ESRD education. The available reports describe program innovations and methods and offer some limited evaluative data and recommendations. Access to patients and lack of reimbursement are significant barriers to expansion of this field. These barriers present the nephrology community with challenges in offering patients optimum treatment and participation in treatment decisions and alternatives. Early patient education is an essential component that can contribute significantly to slowing the progression of renal disease.