Dialysis Modality Survival Comparison: Time to End the Debate, It’s a Tie

Jaar, Bernard G.; Gimenez, Luis F.

doi:10.1053/j.ajkd.2017.10.022

Cited by 7 publications

(5 citation statements)

References 18 publications

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“…However, there are no randomized controlled trials comparing the different modalities of dialysis informing the healthcare professionals' choice 10 . The often quoted superior preservation of residual renal function in patients utilizing peritoneal dialysis may be a factor 11 . UK Renal Registry data suggests a survival advantage of PD over hemodialysis in the initial 2 years of therapy 12 .…”

Section: Discussionmentioning

confidence: 99%

“…10 The often quoted superior preservation of residual renal function in patients utilizing peritoneal dialysis may be a factor. 11 UK Renal Registry data suggests a survival advantage of PD over hemodialysis in the initial 2 years of therapy. 12 This survival advantage extends to patients on PD who switch over to hemodialysis in a timely manner compared with hemodialysis alone.…”

Section: Discussionmentioning

confidence: 99%

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Do we practice what we preach? Dialysis modality choice among healthcare workers in the United Kingdom

Hamer

Hameed

Damery

et al. 2023

Seminars in Dialysis

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BackgroundIn the United Kingdom, over 80% of end‐stage kidney disease patients receive in‐center hemodialysis. We conducted a survey of UK renal healthcare workers on their preferred dialysis modality if they needed dialysis themselves.MethodsAn anonymized online survey was disseminated to all renal healthcare workers in the United Kingdom. We asked “Assume you are an otherwise well 40‐year‐old (and, separately, 75‐year‐old) person approaching end stage kidney disease, you have no living kidney donor options at present. There are no contraindications to any dialysis options. Which dialysis therapy would you choose?” We also asked about factors influencing their choice.Results858 individuals with a median age of 44.3 years responded. 70.2% were female, 37.4% doctors, and 31.1% were senior nurses. There was a preference for peritoneal dialysis over in‐center hemodialysis (50.47% v. 6.18%; p < 0.001 for 40‐year‐old and 49.18% v. 17.83%; p < 0.001 for 75‐year‐old assumption) and home hemodialysis (50.47% v. 39.28%; p < 0.001 for 40‐year‐old and 49.18% v. 18.41% for 75‐year‐old assumption). There was a preference for home hemodialysis over in‐center hemodialysis for 40‐year‐old (39.28% v. 6.18%; p < 0.001) but not for 75‐year‐old. On logistic regression, senior doctors were more likely to opt for PD when compared to nurses. Nurses, allied healthcare professionals, and those of Asian/British Asian ethnicity were more likely to choose in‐center hemodialysis.ConclusionsMost healthcare workers in renal medicine would choose home‐based treatment for themselves although the majority of end‐stage kidney disease patients receive in‐center hemodialysis in the United Kingdom; the reasons for the discrepancy need to be explored.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Do we practice what we preach? Dialysis modality choice among healthcare workers in the United Kingdom

Hamer

Hameed

Damery

et al. 2023

Seminars in Dialysis

View full text Add to dashboard Cite

show abstract

“…In other low-resource settings, explicit CAPD-first programs have been implemented to take advantage of CAPD's technical simplicity, minimal infrastructure requirements, and capability to be carried out in isolated geographic areas [38,39]. Importantly, the prioritization of CAPD at institutions like UNAERC is not an example of scaling a cheaper though clinically inferior treatment [40], as HD and CAPD are both accepted dialysis modalities with generally similar clinical effectiveness [41,42]. At the same time, the use of an informal rather than formal CAPD-first policy may feel coercive to some patients, particularly since prior CAPD patients are prioritized for limited HD slots.…”

Section: Discussionmentioning

confidence: 99%

Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals

Flood

Wilcox

Ferro³

et al. 2020

BMC Nephrol

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Background: Chronic kidney disease (CKD) is increasing worldwide, and the majority of the CKD burden is in lowand middle-income countries (LMICs). However, there is wide variability in global access to kidney care therapies such as dialysis and kidney transplantation. The challenges health professionals experience while providing kidney care in LMICs have not been well described. The goal of this study is to elicit health professionals' perceptions of providing kidney care in a resource-constrained environment, strategies for dealing with resource limitations, and suggestions for improving kidney care in Guatemala. Methods: Semi-structured interviews were performed with 21 health professionals recruited through convenience sampling at the largest public nephrology center in Guatemala. Health professionals included administrators, physicians, nurses, technicians, nutritionists, psychologists, laboratory personnel, and social workers. Interviews were recorded and transcribed in Spanish. Qualitative data from interviews were analyzed in NVivo using an inductive approach, allowing dominant themes to emerge from interview transcriptions. Results: Health professionals most frequently described challenges in providing high-quality care due to resource limitations. Reducing the frequency of hemodialysis, encouraging patients to opt for peritoneal dialysis rather than hemodialysis, and allocating resources based on clinical acuity were common strategies for reconciling high demand and limited resources. Providers experienced significant emotional challenges related to high patient volume and difficult decisions on resource allocation, leading to burnout and moral distress. To improve care, respondents suggested increased budgets for equipment and personnel, investments in preventative services, and decentralization of services. Conclusions: Health professionals at the largest public nephrology center in Guatemala described multiple strategies to meet the rising demand for renal replacement therapy. Due to systems-level limitations, health professionals faced difficult choices on the stewardship of resources that are linked to sentiments of burnout and moral distress. This study offers important lessons in Guatemala and other countries seeking to build capacity to scale-up kidney care.

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“…1 –6 Given that randomized controlled trials on this topic are scarce, 7 the level of evidence is generally from observational studies. Although it was reported that only a minimal survival difference exists between the two dialysis modalities, 8 –12 applying the study results requires careful interpretation, because there are various differences in covariables and biases between the study populations. 9,13,14 Dialysis outcome reports from Asian countries are very limited.…”

Section: Introductionmentioning

confidence: 93%

Changes in mortality hazard of the Korean long-term dialysis population: The dependencies of time and modality switch

Jeong

Kim

et al. 2020

Perit Dial Int

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Background: Many studies have compared patient survival outcome between hemodialysis (HD) and peritoneal dialysis (PD); however, time-varying risks of dialysis modality have been rarely investigated. This study aimed to investigate dialysis modality switch and its association with the survival outcome in the Korean population. Methods: Data from the Korean Society of Nephrology were used. A total of 21,840 incident dialysis patients who started dialysis in or after 2000 were analyzed. For the survival analysis, both proportional and non-proportional hazard assumptions were applied. For the modality switch, time-varying covariate Cox regression was applied. Results: During the median follow-up of 8 years, PD group showed increased adjusted hazard ratio (HR) of 1.248 (95% CI 1.071–1.454, p = 0.004) for mortality. Interaction of PD status with female sex was significant with an HR of 1.080 (95% CI 1.000–1.165, p = 0.050). Dialysis modality switch was associated with increased HR of 1.094 (95% CI 1.015–1.180, p = 0.019), albeit switch from PD to HD did not show significant HR until 6 years. Interestingly, time-varying risk analysis showed a decreased HR of PD after 10 years in the non-switcher group, which was consistent in patients with high traditional risk factors (with diabetes, elderly). Conclusions: PD was associated with increased HR of mortality in the first 8 years, then it was associated with decreased HR of mortality after 10 years. Dialysis modality switch was associated with increased mortality risk, but switch from PD to HD within 6 years did not show significant hazard of mortality.

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Dialysis Modality Survival Comparison: Time to End the Debate, It’s a Tie

Cited by 7 publications

References 18 publications

Do we practice what we preach? Dialysis modality choice among healthcare workers in the United Kingdom

Do we practice what we preach? Dialysis modality choice among healthcare workers in the United Kingdom

Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals

Changes in mortality hazard of the Korean long-term dialysis population: The dependencies of time and modality switch

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