Original InvestigationDialysisDifferences Between Dialysis Modality Selection and Initiation
Section snippets
Population
This was a retrospective study encompassing all patients receiving dialysis modality education at the University of Rochester between January 1, 2004, and October 29, 2009. Patients who underwent education and subsequently started dialysis therapy as of October 5, 2010, were included.
Patients choosing PD who received education within 2 weeks of starting dialysis therapy were excluded because starting PD would not be feasible in such a short period. Patients with a known medical contraindication
Modality Choice Based on Initial Selection
Of approximately 1,800 incident dialysis patients during 6 years, 227 received education between January 1, 2004, and October 29, 2009. Of these, 8 patients choosing PD were excluded due to receiving education less than 2 weeks before starting dialysis therapy (n = 6) or having a medical contraindication to PD (n = 2; one patient had surgery with involvement of the peritoneal cavity immediately before dialysis therapy start and the other had a long-term indwelling drain of a blind intestinal
Discussion
This study shows that many patients start dialysis with HD despite choosing PD as their modality of choice, and only a minority of patients transition to PD. We found few predictors of this mismatch: age older than 75 years, employment status, and, to a degree, cause of ESRD and nonwhite race. Our study is unique in that it considers the initial dialysis modality choice by patient, not only the actual dialysis modality used.
Age older than 75 years predicted an HD start in our cohort, even in
Acknowledgements
Part of this work was presented in abstract form at the annual meeting of the American Society of Nephrology, November 16-21, 2010, Denver, CO.
Support: This work was supported by the Buswell Fellowship award (University of Rochester School of Medicine) to Dr Liebman.
Financial Disclosure: The authors declare that they have no relevant financial interests.
References (29)
- et al.
The effect of contraindications and patient preference on dialysis modality selection in ESRD patients in The Netherlands
Am J Kidney Dis
(2004) - et al.
Predicting a patient's choice of dialysis modality: experience in a United Kingdom renal department
Am J Kidney Dis
(2001) - et al.
The financial implications for Medicare of greater use of peritoneal dialysis
Clin Ther
(2009) - et al.
The impact of education on chronic kidney disease patients' plans to initiate dialysis with self-care dialysis: a randomized trial
Kidney Int
(2005) - et al.
Clinical outcomes, quality of life, and costs in the North Thames Dialysis Study of elderly people on dialysis: a prospective cohort study
Lancet
(2000) - et al.
Perceived knowledge among patients cared for by nephrologists about chronic kidney disease and end-stage renal disease therapies
Kidney Int
(2008) - et al.
Awareness of kidney disease in the US population: findings from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2000
Am J Kidney Dis
(2004) - et al.
A systematic review of factors influencing decision-making in adults living with chronic kidney disease
Patient Educ Counsel
(2009) Peritoneal dialysis for older people: overcoming the barriers
Kidney Int
(2008)- et al.
Body size and outcomes on peritoneal dialysis in the United States
Kidney Int
(2003)
USRDS 2009 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States
Influence of a Pre-Dialysis Education Programme (PDEP) on the mode of renal replacement therapy
Nephrol Dial Transplant
Treatment modality selection in 150 consecutive patients starting ESRD therapy
Perit Dial Int
A simplified equation to predict glomerular filtration rate from serum creatinine [abstract]
J Am Soc Nephrol
Cited by (50)
Innovations to Increase Home Hemodialysis Utilization: The Transitional Care Unit
2021, Advances in Chronic Kidney DiseaseCitation Excerpt :In addition, family members can shed light on realities the patient is not accounting for. Voicing concerns and objections early in the process enables dealing with them at an early stage to avoid surprises and frustrations down the road.8 Learning is about transfer of the experience and changing behavior.
The Role of the Chronic Kidney Disease Clinic and Multidisciplinary Team Care
2018, Chronic Kidney Disease, Dialysis, and Transplantation: A Companion to Brenner and Rector’s The KidneyThe Use and Outcomes of Peritoneal Dialysis
2018, Chronic Kidney Disease, Dialysis, and Transplantation: A Companion to Brenner and Rector’s The KidneyFactors affecting the choice of peritoneal dialysis: Perspective of patients and nephrologists
2017, Nephrologie et TherapeutiqueHonoring Patient Preferences: The 2016 National Kidney Foundation Presidential Address
2016, American Journal of Kidney DiseasesEpidemiology and Challenges to the Management of Advanced CKD
2016, Advances in Chronic Kidney DiseaseCitation Excerpt :There is inferential evidence that processes in advanced CKD care important for ESRD preparation may be suboptimal. For example, it is generally observed that there is a failure in the most important critical path step for successful advanced CKD management, that of modality selection for subsequent RRT.24,25 Delay here leads to sequential and interrelated later failures: lost opportunity for preemptive transplant, underutilization of home dialysis, and suboptimal hemodialysis initiation.
Originally published online February 10, 2012.