Choice of dialysis modality among patients initiating dialysis: results of the Peridialysis study

Abstract

Background In patients with end-stage kidney disease (ESKD), home dialysis offers socioeconomic and health benefits compared to in-centre dialysis but is generally underutilized. We hypothesized that pre-dialysis course and institutional factors affect choice of dialysis modality after dialysis initiation (DI). Methods The Peridialysis study is a multinational, multicentre prospective observational study assessing the causes and timing of DI and consequences of suboptimal DI. Clinical and biochemical data, details of the pre-dialytic course, reasons for DI and causes of choice of dialysis modality were registered. Results Among 1587 included patients, 516 (32.5%) were judged unsuitable for home dialysis due to contraindications (384; 24.2%) or no assessment (106; 6.7%; mainly due to late referral and/or suboptimal DI) or death (26; 1.6%). High age, comorbidity, late referral, suboptimal DI, acute illness, and rapid loss of renal function associated with unsuitability. Of the remaining 1071 patients, 700 (65.4%) chose peritoneal dialysis (61.7%) or home haemodialysis (3.6%), while 371 (34.6%) chose in-centre HD. Somatic differences between patients choosing home dialysis and in-centre dialysis were minor; factors linked to choice of in-centre dialysis were late referral, suboptimal DI, acute illness and absence of a “home dialysis first” institutional policy. Conclusions Given a personal choice with shared decision making, 65.4% of ESKD patients choose home dialysis. Our data indicate that the incidence of home dialysis potentially could be further increased to reducing the incidence of late referral and unplanned DI, and, in acutely ill patients, by implementing an educational program after improvement of their clinical condition.

Influence of formalized Predialysis Education Program (fPEP) on the chosen and definitive renal replacement therapy option

“…It seems comparable to previous data; however, more often, the impact of educational intervention on the choice or receipt of RRT method was assessed. [5][6][7][10][11][12][13] Knowledge on a given method not necessarily must mean its choice. It is an essential factor in making a personal, informed decision and adjusting a treatment option to the patient's needs and expectations, making patients willing to learn more about the preferred method.…”

“…2,16,17 The distribution between selected dialysis methods in our study was almost equal -40% patients chose HD and 32% chose PD, which is in line with previous studies. [5][6][7][10][11][12][13] Nevertheless, such distribution can be associated with additional factors that extend beyond patient choice, including patient characteristics, healthcare system, reimbursement policy, provider factors such as "home dialysis first" policy, or clinician behavior.…”

“…In our cohort, 22% of patients have been considered not suitable for free personal choice of dialysis modality, which is similar to previous data. 13,18,19 Medical and psychological (or both) contraindications for the choice of PD were the most common. In general, old age and high comorbidity burden are perceived as contraindications to PD and those patients are less likely to receive PD, even though they have decreased mortality risk on PD.…”

Late Dialysis Modality Education Could Negatively Predict Peritoneal Dialysis Selection

“…Another possibility is that the low percentage of PD selection might be due to an unexpected dialysis start. Delays in RRT education result in an increase in unexpected dialysis initiation and, in this case, HD tends to be favored in many dialysis centers than PD [ 32 , 33 ]. By reducing the likelihood of unscheduled dialysis beginning, early RRT education might lead to non-biased dialysis modality selection.…”

Why Peritoneal Dialysis is Underutilized in the United States: A Review of Inequities

“…PD is an attractive and viable option for individuals whose lives are not compatible with the time constraints and transportation demands that HD places on patients. [1][2][3][4][5][6] Factors Contributing to the Limited Use of Peritoneal Dialysis as a Home Dialysis Modality…”