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Factors influencing renal replacement therapy modality choice from the nephrologist’s perspective

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Abstract

Background

Peritoneal dialysis (PD) offers quality of life and empowerment for persons with end-stage kidney disease (ESKD). Nevertheless, the prevalence of PD is low in Belgium and Europe in general. Reimbursement, patient mix and late referral have been quoted as underlying reasons. However, to date no one-size-fits-all solution increasing uptake of PD has been successfully implemented.

We aimed to understand the nephrologist’s perspective, beliefs, and experiences on dialysis modality selection and to clarify underlying process-level and intrinsic motivations steering final decisions.

Methods

Using purposeful sampling, Belgian nephrologists (non-/academic, geographical spread, age, gender) were selected. We conducted semi-structured interviews, and audiotapes were transcribed verbatim. Meaningful units were grouped into (sub-)themes, and a conceptual framework was developed using grounded theory according to Charmaz as guidance.

Results

Twenty-nine nephrologists were interviewed. We identified four themes: Trust and belief (in PD as a technique; own expertise, knowledge and team; in behavior of patient, family practitioner), feeling of control (paternalism; insecurity; prejudice), vision of care and approach (shared decision making; troubleshooting attitude; flexibility and creativity; complacency), and organizational issues (predialysis; access; financial; and assisted PD).

Conclusions

Based on these interviews, it is apparent that next to already identified singular issues such as late referral, predialysis education, patient mix and financial incentives, more intrinsic factors also impact uptake of home-based therapies. These factors intertwine and relate both to process-level topics and to attitudes and culture of the nephrologists within the team.

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Data availability

Interviews are in native language; the original quotes maybe shared upon reasonable request to the authors.

References

  1. Van Biesen W, Vanholder R, Lameire N (2000) The role of peritoneal dialysis as the first-line renal replacement modality. Perit Dial Int J Int Soc Perit Dial 20(4):375–383 (Epub 2000/09/28)

    Article  Google Scholar 

  2. van de Luijtgaarden MW, Jager KJ, Segelmark M, Pascual J, Collart F, Hemke AC et al (2016) Trends in dialysis modality choice and related patient survival in the ERA-EDTA Registry over a 20-year period. Nephrol Dial Transplant Off Publ Eur Dial Transplant Assoc Eur Ren Assoc 31(1):120–128. https://doi.org/10.1093/ndt/gfv295

    Article  Google Scholar 

  3. Oliver MJ, Garg AX, Blake PG, Johnson JF, Verrelli M, Zacharias JM et al (2010) Impact of contraindications, barriers to self-care and support on incident peritoneal dialysis utilization. Nephrol Dial Transplant Off Publ Eur Dial Transplant Assoc Eur Ren Assoc 25(8):2737–2744. https://doi.org/10.1093/ndt/gfq085. (Epub 2010/03/02)

    Article  Google Scholar 

  4. van der Tol A, Lameire N, Morton RL, Van Biesen W, Vanholder R (2019) An International analysis of dialysis services reimbursement. Clin J Am Soc Nephrol CJASN 14(1):84–93. https://doi.org/10.2215/CJN.08150718

    Article  PubMed  Google Scholar 

  5. Walker RC, Howard K, Morton RL, Palmer SC, Marshall MR, Tong A (2016) Patient and caregiver values, beliefs and experiences when considering home dialysis as a treatment option: a semi-structured interview study. Nephrol Dial Transplant Off Publ Eur Dial Transplant Assoc Eur Ren Assoc 31(1):133–141. https://doi.org/10.1093/ndt/gfv330. (Epub 2015/09/09)

    Article  Google Scholar 

  6. Viglino G, Neri L, Alloatti S, Cabiddu G, Cocchi R, Limido A et al (2007) Analysis of the factors conditioning the diffusion of peritoneal dialysis in Italy. Nephrol Dial Transplant Off Publ Eur Dial Transplant Assoc Eur Ren Assoc 22(12):3601–3605 (Epub 2007/07/03)

    Google Scholar 

  7. Chambers JD, Weiner DE, Bliss SK, Neumann PJ (2013) What can we learn from the US expanded end-stage renal disease bundle? Health Policy 110(2–3):164–171. https://doi.org/10.1016/j.healthpol.2013.01.011

    Article  PubMed  Google Scholar 

  8. Tabinor M, Casula A, Wilkie M, Davies S, Caskey F, Lambie M (2017) UK Renal Registry 19th Annual Report Chapter13 home therapies in 2015: national and centre-specific analyses. Nephron 137(1):297–326. https://doi.org/10.1159/000481376

    Article  PubMed  Google Scholar 

  9. Hingwala J, Diamond J, Tangri N, Bueti J, Rigatto C, Sood MM et al (2013) 2013 Underutilization of peritoneal dialysis: the role of the nephrologist’s referral pattern. Nephrol Dial Transplant Off Publ Eur Dial Transplant Assoc Eur Ren Assoc 28(3):732–740. https://doi.org/10.1093/ndt/gfs323

    Article  CAS  Google Scholar 

  10. Lameire N, Wauters JP, Teruel JL, Van Biesen W, Vanholder R (2002) An update on the referral pattern of patients with end-stage renal disease. Kidney Int Suppl 80:27–34. https://doi.org/10.1046/j.1523-1755.61.s80.6.x. (Epub 2002/05/02)

    Article  Google Scholar 

  11. Lobbedez T, Verger C, Ryckelynck JP, Fabre E, Evans D (2013) Outcome of the sub-optimal dialysis starter on peritoneal dialysis Report from the French Language Peritoneal Dialysis Registry (RDPLF). Nephrol Dial Transplant Off Publ Eur Dial Transplant Assoc Eur Ren Assoc 28(5):1276–1283. https://doi.org/10.1093/ndt/gft018. (Epub 2013/03/12)

    Article  Google Scholar 

  12. Van Biesen W, van der Veer SN, Murphey M, Loblova O, Davies S (2014) Patients’ perceptions of information and education for renal replacement therapy: an independent survey by the European Kidney Patient’s Federation on information and support on renal replacement therapy. PloS One 9(7):e103914. https://doi.org/10.1371/journal.pone.0103914. (Epub 2014/08/01)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Morton RL, Snelling P, Webster AC, Rose J, Masterson R, Johnson DW et al (2012) Dialysis modality preference of patients with CKD and family caregivers: a discrete-choice study. Am J Kidney Dis Off J Natl Kidney Found 60(1):102–111. https://doi.org/10.1053/j.ajkd.2011.12.030. (Epub 2012/03/16)

    Article  Google Scholar 

  14. Kurella Tamura M, Li S, Chen SC, Cavanaugh KL, Whaley-Connell AT, McCullough PA et al (2013) Educational programs improve the preparation for dialysis and survival of patients with chronic kidney disease. Kidney Int. https://doi.org/10.1038/ki.2013.369. (Epub 2013/09/27)

    Article  PubMed  Google Scholar 

  15. Rioux JP, Cheema H, Bargman JM, Watson D, Chan CT (2011) Effect of an in-hospital chronic kidney disease education program among patients with unplanned urgent-start dialysis. Clin J Am Soc Nephrol CJASN 6(4):799–804. https://doi.org/10.2215/CJN.07090810

    Article  PubMed  Google Scholar 

  16. Abdel Aal AK, Mahmoud K, Moustafa AS, Aboueldahab NA, Souid A, Gunn A et al (2020) Comparative study on the outcomes of elective-start versus urgent-start peritoneal dialysis catheter placement. Radiol Res Pract 2020:3751827. https://doi.org/10.1155/2020/3751827

    Article  PubMed  PubMed Central  Google Scholar 

  17. van Eck van der Sluijs A, van Jaarsveld BC, Allen J, Altabas K, Bechade C, Bonenkamp AA et al (2021) Assisted peritoneal dialysis across Europe: Practice variation and factors associated with availability. Perit Dial Int J Int Soc Perit Dial 41(6):533–541. https://doi.org/10.1177/08968608211049882

    Article  Google Scholar 

  18. Hahn Lundstrom U, Abrahams AC, Allen J, Altabas K, Bechade C, Burkhalter F et al (2021) Barriers and opportunities to increase PD incidence and prevalence: Lessons from a European Survey. Perit Dial Int J Int Soc Perit Dial 41(6):542–551. https://doi.org/10.1177/08968608211034988. (PMID: 34409901)

    Article  Google Scholar 

  19. Arramreddy R, Zheng S, Saxena AB, Liebman SE, Wong L (2014) Urgent-start peritoneal dialysis: a chance for a new beginning. Am J Kidney Dis 63(3):390–395. https://doi.org/10.1053/j.ajkd.2013.09.018

    Article  PubMed  Google Scholar 

  20. Charmaz K (2006) Constructing grounded theory. Sage, London

    Google Scholar 

  21. Tong A, Sainsbury P, Craig J (2007) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Healthc J Int Soc Qual Healthc ISQua 19(6):349–357. https://doi.org/10.1093/intqhc/mzm042

    Article  Google Scholar 

  22. Morton RL, Tong A, Howard K, Snelling P, Webster AC (2010) The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies. BMJ. https://doi.org/10.1136/bmj.c112. (Epub 2010/01/21 PMC2808468)

    Article  PubMed  PubMed Central  Google Scholar 

  23. de Jong RW, Jager KJ, Vanholder RC, Couchoud C, Murphy M, Rahmel A et al (2021) Results of the European EDITH nephrologist survey on factors influencing treatment modality choice for end-stage kidney disease. Nephrol Dial Transplant Off Publ Eur Dial Transplant Assoc Eur Ren Assoc 37(1):126–138. https://doi.org/10.1093/ndt/gfaa342

    Article  Google Scholar 

  24. Song MK, Lin FC, Gilet CA, Arnold RM, Bridgman JC, Ward SE (2013) Patient perspectives on informed decision-making surrounding dialysis initiation. Nephrol Dial Transplant Off Publ Eur Dial Transplant Assoc Eur Ren Assoc 28(11):2815–2823 (Epub 2013/08/01)

    Google Scholar 

  25. Moreels T, Van de Velde D, Van Duyse S, Vanden Wyngaert K, Leune T, Van Biesen W, De Vriendt P (2023) The impact of in-centre haemodialysis treatment on the everyday life of older adults with end-stage kidney disease: a qualitative study. Clin Kidney J 16:1647–1683

    Article  Google Scholar 

  26. Van Biesen W, Verbeke F, Vanholder R (2009) We don’t need no education (Pink Floyd, The Wall) Multidisciplinary predialysis education programmes: pass or fail? Nephrol Dial Transplant Off Publ Eur Dial Transplant Assoc Eur Ren Assoc 24(11):3277–3279. https://doi.org/10.1093/ndt/gfp448. (Epub 2009/09/09)

    Article  Google Scholar 

  27. van Dulmen S, Peereboom E, Schulze L, Prantl K, Rookmaaker M, van Jaarsveld BC et al (2022) The use of implicit persuasion in decision-making about treatment for end-stage kidney disease. Perit Dial Int J Int Soc Perit Dial 42(4):377–386. https://doi.org/10.1177/08968608211027019

    Article  Google Scholar 

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Acknowledgements

We thank all the nephrologists participating in the interviews for their honesty and time. Also, we thank the secretaries for typing all interviews verbatim. The study was approved by the Ethical Committee of the University Hospital Ghent (THE-2022-0179).

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Authors and Affiliations

  1. Renal Division, University Hospital Gent, Gent, Belgium

    Charlotte Cortvrindt & Wim Van Biesen

  2. Department of Internal Medicine and Paediatrics, University of Gent, Ghent, Belgium

    Wim Van Biesen

  3. Service de Néphrologie dialyse et transplantation, Hôpital Erasme, ULB, Brussels, Belgium

    Guiseppe Gambino & Anne-Lorraine Clause

Authors
  1. Charlotte Cortvrindt
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  2. Wim Van Biesen
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  3. Guiseppe Gambino
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  4. Anne-Lorraine Clause
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Contributions

All authors contributed substantially to this current paper according to the ICMJE criteria: conception or design of the work (WVB, CC, A-LC, GG); acquisition of data through interviews (CC, A-LC), analysis and interpretation of data (CC, A-LC, GG, WVB). Drafting and critical revision of the paper for important intellectual content (WVB, A-LC, CC, GG). All authors gave final approval of the version to be published, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Wim Van Biesen.

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Conflict of interest

The authors declare they have no conflict of interest with regard to the presented research.

Ethical approval

The study was approved by the Ethical Committee of the University Hospital Ghent (THE-2022-0179). The study was conducted according to the guidelines of the Declaration of Helsinki.

Human and animal rights

The present study complies with the guidelines for human studies. The current study does not involve animals.

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Informed consent was obtained from all persons involved in the study.

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Cortvrindt, C., Van Biesen, W., Gambino, G. et al. Factors influencing renal replacement therapy modality choice from the nephrologist’s perspective. J Nephrol (2024). https://doi.org/10.1007/s40620-024-01915-w

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