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Modality Selection

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The Essentials of Clinical Dialysis

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Abstract

Chronic kidney disease (CKD), one of the most prevalent chronic diseases worldwide, eventually progresses to end-stage renal disease (ESRD), which requires renal replacement therapy (RRT) for patient survival. Kidney transplantation and two dialysis modalities, namely, hemodialysis (HD) and peritoneal dialysis (PD), are the main RRTs available for ESRD patients. Modality selection should be guided by patient preference because (1) general consensus on the optimal modality for ESRD patients is lacking, (2) survival outcomes are not better for any one dialysis modality, and (3) consideration of patient preference generally improves health outcomes. Survival outcomes are largely similar between HD and PD, although the latter has a survival advantage in the early period after starting dialysis. To select the optimal modality, it is crucial to provide comprehensive, unbiased information on the characteristics of each modality along with the benefits and risks in a planned manner. In addition to medical factors, nonmedical factors including socioeconomic factors, the method of reimbursement, functional status, cultural factors, and lifestyle are important to be considered for modality selection. Further, the advantages and disadvantages of each dialysis modality differentially affect modality selection in specific subgroups of patients, for example, the elderly and patients with diabetes. Therefore, patient characteristics and comorbidities should be included in the decision-making model. Lastly, decision-making aids that facilitate modality selection have recently been introduced. As a part of pre-dialysis education, these aids could be useful to patients with declining renal function who need support for dialysis decision-making in accordance with their lifestyles.

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  1. Division of Nephrology, Department of Internal Medicine, Kyungpook National University Hospital, 130 Dongduk-Ro, Jung-Gu, Daegu, 700-721, South Korea

    Sun-Hee Park M.D., Ph.D.

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  1. Division of Nephrology, Kyungpook National University Hospital, Daegu, Korea (Republic of)

    Yong-Lim Kim

  2. Tsuchiya General Hospital, Hiroshima, Japan

    Hideki Kawanishi

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Park, SH. (2018). Modality Selection. In: Kim, YL., Kawanishi, H. (eds) The Essentials of Clinical Dialysis. Springer, Singapore. https://doi.org/10.1007/978-981-10-1100-9_2

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