Pre-Dialysis Education
Empowering Informed Treatment Decisions

The transition to kidney replacement therapy (KRT) — whether dialysis or transplant — is one of the most significant medical and life transitions a person can experience. Patients who receive comprehensive pre-dialysis education are better prepared for this transition, make treatment choices that align with their values and lifestyle, experience fewer emergency dialysis starts, and have better clinical outcomes.

Unfortunately, many patients reach end-stage kidney disease without adequate preparation — leading to emergent dialysis starts through temporary catheters, hospitalization, and suboptimal modality placement. At AKSNB, we believe this is preventable. We begin pre-dialysis education early in Stage 4 CKD, giving patients and their families the time they need to learn, reflect, ask questions, and plan.

Our pre-dialysis education program is not a one-size-fits-all approach. It is individualized, unhurried, and patient-centered — tailored to each person's educational background, health literacy, social support, and life circumstances.

In-Center Hemodialysis: Three sessions per week at a dialysis facility. Well-suited to patients who prefer a structured schedule and professional oversight. Our nephrologists explain what to expect at the dialysis center, what the treatment feels like, and how to prepare for access placement.

Home Hemodialysis: More frequent, shorter hemodialysis sessions performed at home. Offers superior outcomes and greater flexibility. We discuss candidacy criteria, training requirements, and lifestyle implications.

Peritoneal Dialysis: Home-based dialysis using the peritoneal membrane. Allows patients to continue working, traveling, and maintaining a more normal lifestyle. We discuss catheter placement, training, and the day-to-day realities of CAPD and APD.

Kidney Transplant: The best treatment for eligible patients with ESRD, offering superior quality of life and longevity. We identify transplant candidates early and initiate evaluation to maximize time on the waiting list. Pre-emptive transplant (before starting dialysis) is the ideal outcome when possible.

Conservative Kidney Management: For some patients — particularly the elderly or those with significant comorbidities — the goal may be maximizing quality of life without dialysis. We provide honest, compassionate discussions about the role of supportive and palliative care as a legitimate treatment choice.

Planning for dialysis access is a critical part of pre-dialysis care. Arteriovenous fistulas — the preferred vascular access for hemodialysis — require surgical creation and months of maturation before they can be used. For this reason, timely referral to vascular surgery for fistula placement planning is one of the most important things we do for our Stage 4–5 CKD patients who are considering or trending toward hemodialysis.

For peritoneal dialysis patients, PD catheter placement requires coordination with surgery and typically occurs 4–6 weeks before the anticipated start of PD. We coordinate the entire planning process so that when dialysis becomes necessary, the appropriate access is already in place and functional.

We work with renal social workers, dietitians, dialysis centers, transplant programs, and community resources to ensure the pre-dialysis period is comprehensive, well-coordinated, and truly focused on what matters most to each patient.