The Referral Pattern of Patients with Esrd is a Determinant in the Choice of Dialysis Modality

Salvage of Problematic Peritoneal Dialysis Catheters

“…We conclude that in selected cases simple interventions can salvage problematic PD catheters and maintain patients on PD. Although peritoneal dialysis (PD) offers various advantages over hemodialysis, it remains a largely underutilized form of renal replacement therapy, particularly in the United States, where only about 12% of dialysis patients are on PD (1)(2)(3)(4)(5)(6). Nephrologists have recently demonstrated that PD catheter-related issues contribute significantly to enhancing the utilization of PD (7)(8)(9).…”

Shorter break‐in period is a viable option with tighter PD catheter securing during the insertion

“…18 PD underutilization has been attributed to several factors such as lack of patient education, late patient referral, inadequate PD training and physician bias. [19][20][21][22] A reported increase in PD acceptance, after the catheter insertions by nephrologists, highlighted the influence of catheter insertion practices on PD growth. 23 Shortening of break-in period could probably have a similar growth potential, by avoiding intervening central line insertion and temporary haemodialysis; however, the conventional notion of an increased catheter leak by a reduced break-in period discourages its frequent implementation.…”

The Significance of the Timing of Referral for Renal Care

“…Of the 177 patients who went through this programme 75 (40%) opted for haemodialysis, while 102 (60%) opted for the self-care modality, which included the choice of peritoneal dialysis, self-care haemodialysis in the satellite unit and home haemodialysis--therefore demonstrating the effectiveness of this particular programme. Lameire et al (1997) performed a study encompassing 13 European dialysis centres looking at what impact the referral pattern had on the choice of dialysis modality. Over a two-year period they recruited 1,980 patients who had commenced dialysis.…”

“…Evidence, from research conducted into the referral patterns of patients with chronic kidney disease (CKD) to a nephrologist, has shown an impact on the patient's modality choice and long-term complications. It is considered that this happens because of commencing dialysis in an untimely manner, (Jungers et al 1993;Sesso & Belasco 1996;Lameire et al 1997;Little et al 2001;White et al 2002;Goldstein et al 2004;Mondry et al 2004;Mendelssohn 2005;Mendelssohn et al 2006;Farrington et al 2007;Fluck et al 2007). Some of the consequences identified by this research include a higher mortality rate, increased risk of infection due to inadequate access for dialysis, greater impact on the patient's quality of life due to issues such as lack of education about renal failure, the choices for dialysis treatment and a lack of support for both the patient and their family.…”