What Do American Nephrologists Think About Dialysis Modality Selection?

Mendelssohn, David C.; Mullaney, Scott; Jung, Byungjo; Pg, Blake; Mehta, Rohit

doi:10.1053/ajkd.2001.20573

Cited by 101 publications

(148 citation statements)

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“…Of patients assessed, the proportion that are declared eligible for PD will vary widely (7,8,(12)(13)(14). Key factors will include the age and overall comorbidity burden of the population being accepted for dialysis.…”

Section: Step 2: Assessment For Pd Eligibilitymentioning

confidence: 99%

“…The element of experience and confidence may also be such that, compared with newer PD programs, more established PD programs might be more "aggressive" about offering PD to "marginal" patients. When centers are compared, the estimated proportion of patients eligible to do PD is highly variable, typically running between 40% and 80%-thus being a major determinant of a program's ultimate PD utilization percentage (7,8,(12)(13)(14). The whole topic of perceived eligibility and ineligibility to do PD is an area that needs extensive research, and we think that application of the process we are suggesting would be helpful in highlighting inappropriate differences between PD programs.…”

Section: Step 2: Assessment For Pd Eligibilitymentioning

confidence: 99%

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Peritoneal Dialysis and the Process of Modality Selection

2012

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The process of modality selection and how it works is a critical determinant of peritoneal dialysis (PD) utilization. This very complex process has not been well analyzed. Here, we break it down into 6 steps and point out how problems at each step can significantly reduce the proportion of endstage renal disease patients initiating PD. It is important that any program wising it to grow its use of PD understand the steps and the points at which problems may be arising. Examples are presented. Perit Dial Int

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Section: Step 2: Assessment For Pd Eligibilitymentioning

confidence: 99%

Section: Step 2: Assessment For Pd Eligibilitymentioning

confidence: 99%

Peritoneal Dialysis and the Process of Modality Selection

2012

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“…Appendix, www.karger.com?doi=10.1159/000324396). The questionnaires used by previous studies were reviewed [10,11,12]. The instrument used for the present study was then developed as follows: A focused group discussion involving 8 nephrologists in clinical practice was conducted to explore factors perceived to affect modality selection in clinical practice.…”

Section: Methodsmentioning

confidence: 99%

Factors Influencing Dialysis Modality for End-Stage Renal Disease in Developing Countries: A Survey of Filipino Nephrologists

et al. 2011

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Background: In the Philippines, 86% of incident dialysis patients are started on hemodialysis (HD) and 14% are treated with peritoneal dialysis (PD), representing a decline over a 2-year period. One important factor which affects patients’ choice of dialysis modality is the input of their physicians. Our objective was to identify the factors affecting attitudes and recommendations of Filipino nephrologists regarding HD and PD. Methods: Attendees of the annual national nephrology meeting completed an anonymous self-administered questionnaire. Results: Respondents were heavily involved in clinical dialysis work, and 86.7% had most/all of their patients on HD. Recommendations about dialysis modality were based most strongly on overall cost to patient (4.4 on a scale of 1 [not important] to 5 [most important], residual renal function (RRF) preservation (4.4), patient preference (4.3) availability of dialysis support staff (4.3), and comparative quality of life data (4.3). Least important was physician reimbursement (2.8). Patient-related factors favoring HD were: poor personal hygiene, impaired vision and manual dexterity; while favoring PD were: age <10 years, living far from HD unit, and the availability of trainable family members. When asked which modality they would recommend to an equally eligible patient, 49.2% responded they would not recommend either modality and would allow the patient to choose, while 40.7% would recommend HD and 10.2% would recommend PD. Conclusion: Respondents consider overall cost and RRF preservation as the most important factors in dialysis modality selection, yet only 10.2% would recommend PD as first choice. It is likely that factors other than those addressed in the survey are stronger determinants of the patient’s final choice of modality.

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“…This should not be framed as hemodialysis versus PD but as home dialysis (home hemodialysis or PD) versus incenter hemodialysis. Surveys from several countries have shown that nephrologists believe that about one third of the ESRD population would be appropriate for PD (15,16). However, the prevalence of PD as RRT varies dramatically from country to country: from essentially 0% to .80% where payers promote a PD-first policy.…”

Section: Modality Choicementioning

confidence: 99%

Timing of Initiation of RRT and Modality Selection

Bargman¹

2015

Clinical Journal of the American Society of Nephrology

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There is no shortage of studies and registry data examining outcomes of patients on dialysis and those with a renal transplant. However, recently, there has been a greater focus on the events leading up to the institution of kidney replacement therapy. Associative data suggest that early and consistent predialysis care leads to better outcomes, including greater take-on to home-based therapy, diminished use of tunneled venous hemodialysis catheters, and improved early and even late survival. What transpires during predialysis visits is also important. Simple dissemination of facts to the unprepared patient is unlikely to be effective in moving the patient and family along in the process of the series of choices that have to be made around therapy. A more flexible and circumspect approach is needed, including recognizing when the patient is or is not ready for change. There seems to be no optimal timing of dialysis start that can be applied to the ESRD population as a whole, although the pendulum seems to be swinging back toward symptom-based rather than eGFR-based starts.

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What Do American Nephrologists Think About Dialysis Modality Selection?

Cited by 101 publications

References 0 publications

Peritoneal Dialysis and the Process of Modality Selection

Peritoneal Dialysis and the Process of Modality Selection

Factors Influencing Dialysis Modality for End-Stage Renal Disease in Developing Countries: A Survey of Filipino Nephrologists

Timing of Initiation of RRT and Modality Selection

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