Multidisciplinary predialysis education programmes: pass or fail?

In the famous Pink Floyd song, education fails as it reduces every pupil in a totalitarian way to ‘another brick in the wall’. Recently, much attention has been paid to timely referral and multidisciplinary predialysis education (MPE) programmes (for review see [1]). In this issue of Nephrology Dialysis Transplantation (NDT), Wu et al. [2] report the results of a non-randomized observational trial on the impact of an established MPE programme on the outcome of patients with chronic kidney disease (CKD) stage 3 or higher. The authors conclude that such an MPE programme decreases the number of patients ending up on dialysis, and reduces mortality. In what follows, we try to discuss why some methodological aspects of studying the effect of MPE make that the question whether all centres should have MPE programmes cannot be answered by a definite ‘yes’; as such, we also try to offer some explanations why MPE programmes seem to work in some but not in all studies.