Socioeconomic Aspects of Peritoneal Dialysis in North America: Role of Non Medical Factors in the Choice of Dialysis

Venkataraman, Vijaya; Nolph, Karl D.

doi:10.1177/089686089901902s68

Cited by 10 publications

(11 citation statements)

References 10 publications

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“…However, in India, PD is very much an underused modality for renal replacement therapy (RRT), with only 6% of the dialysis population on PD (2). Studies in the West that have looked into the factors affecting the rate of use of PD have found that various nonmedical factors such as financial / reimbursement, educational deficits, physician bias, resource availability, and cultural habits influence the rate of use of PD (3,4). However, no study has looked into the factors that influence the rate of use of PD in India.…”

mentioning

confidence: 99%

Factors Affecting the use of Peritoneal Dialysis among the Esrd Population in India: A Single-Center Study

et al. 2004

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Objectives Factors such as limited health-care budget allotment and poor accessibility of the majority of the population to hemodialysis (HD) facilities should favor the use of peritoneal dialysis (PD) in India. However, only 6% of end-stage renal disease patients undergoing dialysis in India are on PD. We undertook this prospective study to evaluate various factors that could contribute to this low rate of use of PD at a tertiary-care state-run hospital in Northern India. Methods All the patients who entered our HD or PD program from August 2001 to December 2003 were interviewed using a preset questionnaire. The questionnaire recorded their basic disease and comorbidity, social and demographic characteristics, awareness of the various modalities of renal replacement therapy (RRT), and the reasons for choosing their present modality of therapy. Treating nephrologists were also interviewed with respect to the factors that, in their opinion, were responsible for the limited use of PD at our institute. Results In total, 342 patients on HD, 66 patients on PD, and 24 nephrologists were interviewed. The rate of PD use was 16.2%. Mean age of patients on HD and PD was 34.6 ± 11.8 years and 62.9 ± 10.3 years respectively ( p < 0.0001). The incidence of diabetes mellitus and coronary artery disease in the HD and PD populations was 2.5% and 62.5%, and 9.1% and 46.7% respectively ( p < 0.0001 for both). Only 30.4% of patients on HD were aware of PD as a modality of RRT and 83.6% of them found PD to be expensive, 65.4% had low enthusiasm toward a domiciliary therapy such as PD, and 61.5% were not recommended PD by their nephrologist. Only 5 (7.6%) patients were initiated on PD directly, the remaining 61 patients were shifted from HD after a mean duration on HD of 185.3 ± 15.4 days: 67.1% were shifted due to poor tolerance of HD, 29.4% were advised to shift to PD because of comorbidity and vascular access problems, and only 3.3% took up PD because of the independent lifestyle it offered. None of the interviewed nephrologists routinely discussed PD in predialysis counseling. They found financial constraints (100%), lack of patient enthusiasm (100%), doubtful patient compliance (83.2%), and lack of an organized PD program (79.2%) to be the main factors limiting more widespread use of PD at our institute. Conclusions Peritoneal dialysis is an underused modality of RRT at our institute. The patients who are taken up for PD at our institute are elderly and have a higher incidence of other comorbid conditions, such as diabetes mellitus and coronary artery disease. Also, most patients who switch to PD do so due to their unsuitability for HD rather than by their own choice. The factors contributing to this low rate of use of PD are ignorance of PD, increased cost of therapy, low enthusiasm toward domiciliary therapy, and lack of adequate infrastructure for PD at our institute. Effective predialysis counseling, reduction in the cost of the therapy, and development of an adequate infrastructure can increase the rate of use of PD.

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confidence: 99%

Factors Affecting the use of Peritoneal Dialysis among the Esrd Population in India: A Single-Center Study

et al. 2004

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“…peritoneal adhesions because of previous abdominal surgery, poor sight and hand muscle dyssynergia) (Davies 2007;Hu & Lin 1999;Jager et al 2004;Kuriyama 2007;Stack 2002;Whittaker & Albee 1996;Zhao & Wang 2003). Patients can also be strongly influenced by the medical advice given to them, especially if the medical staff have a preference for one particular type of dialysis over another (Hu & Lin 1999;Jager et al 2004;Mendelssohn et al 2001;Nesrallah & Mendelssohn 2006;Thamer et al 2000;Venkataraman & Nolph 1999).…”

Section: Health Care-related Factorsmentioning

confidence: 99%

Factors affecting peritoneal dialysis selection in Taiwanese patients with chronic kidney disease

Liang¹,

Yang²,

Lu³

et al. 2011

International Nursing Review

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Self-care ability and the person's knowledge of the different types of dialysis modality and how they function were the major determinants for selection of dialysis type in Taiwan based on the results from this study. The results indicate that the education of CRF patients about the types of dialysis available is essential to enable them to understand the benefits or limitations of both types of dialysis.

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“…In the U.S.A. there is severe pressure to contain cost through limitation of the per-treatment reimbursement rate, which has not kept up with inflation (17,18). This, combined with the private for-profit ownership of many facilities, creates pressures that might lead to suboptimal treatment quality (19,20).…”

Section: What Are the Economically Derived Problems In Dialysis Care?mentioning

confidence: 99%

A Call to Arms: Economic Barriers to Optimal Dialysis Care

McFarlane

Mendelssohn

2000

Perit Dial Int

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Epidemic growth rates and the enormous cost of dialysis pressure end-stage renal disease (ESRD) delivery systems around the world. Payers of dialysis services can constrain costs through ( 1 ) limiting access to dialysis, ( 2 ) reducing the quality of dialysis, and ( 3 ) placing constraints on modality distribution. In order to secure the necessary resources for ESRD care, we propose that the nephrology community consider the following suggestions: First, future leaders in dialysis should acquire additional advanced training in innovative pathways such as health care economics, business and health care administration, and health care policy. Second, the international nephrology community must strongly engage in ongoing advocacy for accessible, high quality, cost-effective care. Third, efforts should be made to better define and then implement optimal dialysis modality distributions that maximize patient outcomes but limit unnecessary costs. Fourth, industry should be encouraged to lower the unit cost of dialysis, allowing for improved access to dialysis, especially in developing countries. Fifth, research should be encouraged that seeks to identify measures that will reduce dialysis costs but will not impair quality of care. Finally, early referral of patients with progressive renal disease to nephrology clinics, empowerment of informed patient choice of dialysis modality, and proper and timely access creation should be encouraged and can be expected to help limit overall expenditures. Ongoing efforts in these areas by the nephrology community will be essential if we are to overcome the challenges of ESRD growth in this new decade.

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Socioeconomic Aspects of Peritoneal Dialysis in North America: Role of Non Medical Factors in the Choice of Dialysis

Cited by 10 publications

References 10 publications

Factors Affecting the use of Peritoneal Dialysis among the Esrd Population in India: A Single-Center Study

Factors Affecting the use of Peritoneal Dialysis among the Esrd Population in India: A Single-Center Study

Factors affecting peritoneal dialysis selection in Taiwanese patients with chronic kidney disease

A Call to Arms: Economic Barriers to Optimal Dialysis Care

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