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Dialysis modality choices among chronic kidney disease patients: identifying the gaps to support patients on home-based therapies

  • Nephrology – Original Paper
  • Published:
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Abstract

Background

Home dialysis is a cost-effective renal replacement strategy, which provides improved quality of life compared to conventional in-center hemodialysis (CHD). To date, most studies support the use of multidisciplinary chronic kidney disease (CKD) clinics to facilitate timely initiation of dialysis. This is an observational cohort study examining 486 patients with CKD over the period of 2001–2007 to ascertain potential demographic differences among patients transitioned to in-center versus home dialysis.

Subjects and methods

From January 2001 to December 2007, 486 patients with CKD attended the multidisciplinary renal management clinic at the University Health Network in Toronto.

Results

One hundred and fifty-three of the 486 patients were initiated on renal replacement therapy [59 to center hemodialysis (CHD), 15 to home hemodialysis (HHD) and 79 to home peritoneal dialysis (PD)]. HHD patients were younger (48 ± 15 years) than those who selected CHD (62 ± 16 years) or PD (64 ± 16 years). Although the gender distribution was similar overall, the percentage of single males was higher in CHD versus home dialysis patients (29 vs. 15%, P < 0.05). There were no significant differences in other demographic, clinical and biochemical parameters at the time of dialysis initiation. Disinterest in home dialysis by patients and their families (25.4%) and lack of social support (12.1%) constituted the main barriers to home dialysis. Medical contraindications for home dialysis were present among 11% of the patients. Other less frequent barriers were inadequate space, communication barrier and inability to perform their own dialysis.

Conclusions

Sixty-one percent of patients requiring dialysis chose a home dialysis modality. Patients’ and their families’ disinterest in home dialysis and lack of support (either perceived or actual) represented the major overall barriers to adoption of home dialysis.

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References

  1. Rubin HR, Fink NE, Plantinga LC et al (2004) Patient ratings of dialysis care with peritoneal dialysis versus hemodialysis. JAMA 291:697–703

    Article  CAS  PubMed  Google Scholar 

  2. Foley RN, Collins AJ (2007) End-stage renal disease in the United States: an update from the United States Renal Data System. J Am Soc Nephrol 18:2644–2648

    Article  PubMed  Google Scholar 

  3. Li PK, Lui SL, Leung CB et al (2007) Increased utilization of peritoneal dialysis to cope with mounting demand for renal replacement therapy—perspectives from Asian countries. Perit Dial Int 27(Suppl 2):S59–S61

    PubMed  Google Scholar 

  4. Mcgregor MS, Agar JW, Blagg CR (2006) Home hemodialysis international trends and variation. Nephrol Dial Transplant 21:1934–1945

    Article  Google Scholar 

  5. Mendelssohn DC, Mujais SK, Soroka SD et al (2009) A prospective evaluation of renal replacement therapy modality eligibility. Nephrol Dial Transplant 24(2):555–561

    Article  PubMed  Google Scholar 

  6. Mendelssohn DC, Pierratos A (2002) Reformulating the integrated care concept for the new millennium. Perit Dial Int 22:5–8

    PubMed  Google Scholar 

  7. Bernardini J, Price V, Figueiredo A et al (2006) International survey of peritoneal dialysis training programs. Perit Dial Int 26:658–663

    PubMed  Google Scholar 

  8. Levin A, Lewis M, Mortiboy P et al (1997) Multidisciplinary predialysis programs: quantification and limitations of their impact on patient outcomes in two Canadian settings. Am J Kidney Dis 29:533–540

    Article  CAS  PubMed  Google Scholar 

  9. Curtis BM, Barret BJ, Jindal K et al (2002) Canadian survey of clinical status at dialysis initiation 1998–1999: a multicenter prospective survey. Clin Nephrol 58:282–288

    CAS  PubMed  Google Scholar 

  10. Van Manen JG, Korevaar JC, Dekker FW et al (2003) NECOSAD-study group. Adjustment for comorbidity in studies on health status in ESRD patients: which comorbidity index to use? J Am Soc Nephrol 14:478–485

    Article  PubMed  Google Scholar 

  11. Oreopoulos DG, Thodis E, Passadakis P et al (2003) Home dialysis as a first option: a new paradigm. Int Urol Nephrol 41(3):595–605 [Epub 2009 May 9 Review]

    Google Scholar 

  12. Liakopoulos V, Stefanidis I, Dombros NV (2010) Peritoneal dialysis glossary 2009. Int Urol Nephrol 42(2):417–423

    Article  PubMed  Google Scholar 

  13. Mendelssohn DC, Mullaney SR, Jung B et al (2001) What do American nephologists think about dialysis modality selection? Am J Kidney Dis 37:22–29

    CAS  PubMed  Google Scholar 

  14. Jung B, Blake PG, Mehta RL et al (1999) Attitudes of Canadian nephrologists toward dialysis modality selection. Perit Dial Int 19:263–268

    CAS  PubMed  Google Scholar 

  15. Miskulin DC, Meyer KB, Athienites NV et al (2002) Comorbidity and other factors associated with modality selection in incident dialysis patients: the CHOICE Study. Choices for healthy outcomes in caring for end-stage renal disease. Am J Kidney Dis 39:324–336

    Article  PubMed  Google Scholar 

  16. Stack AG (2002) Determinants of modality selection among incident US dialysis patients: results from a national study. J Am Soc Nephrol 13:1279–1287

    PubMed  Google Scholar 

  17. Jager KJ, Korevaar JC, Dekker FW et al (2004) Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) Study Group: the effect of contraindications and patient preference on dialysis modality selection in ESRD patients in The Netherlands. Am J Kidney Dis 43:891–899

    Article  PubMed  Google Scholar 

  18. Winkelmayer WC, Glynn RJ, Levin R et al (2001) Late referral and modality choice in end-stage renal disease. Kidney Int 60:1547–1554

    Article  CAS  PubMed  Google Scholar 

  19. Fong E, Bargman JM, Chan CT (2007) Cross-sectional comparison of quality of life and illness intrusiveness in patients who are treated with nocturnal home hemodialysis versus peritoneal dialysis. Clin J Am Soc Nephrol 2:1195–1200

    Article  PubMed  Google Scholar 

  20. Oliver MJ, Quinn RR, Richardson EP et al (2007) Home care assistance and the utilization of peritoneal dialysis. Kidney Int 71:673–678

    Article  CAS  PubMed  Google Scholar 

  21. Agraharkar M, Barclay C, Agraharkar A (2002) Staff-assisted home hemodialysis in debilitated or terminally ill patients. Int Urol Nephrol 33:139–144

    Article  PubMed  Google Scholar 

  22. Just PM, de Charro FT, Tschosik EA et al (2008) Reimbursement and economic factors influencing dialysis modality choice around the world. Nephrol Dial Transplant 23:2365–2373

    Article  PubMed  Google Scholar 

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Acknowledgments

Dr. Chan holds the R Fraser Elliott Chair in Home Dialysis. The authors would like to thank the staff members of the home dialysis team and the Renal Management Clinic.

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Authors and Affiliations

  1. Division of Nephrology, Peking University Third Hospital, Beijing, China

    Ai-Hua Zhang

  2. Division of Nephrology, University Health Network, Toronto, ON, Canada

    Ai-Hua Zhang, Joanne M. Bargman, Charmaine E. Lok, Eveline Porter, Maria Mendez, Dimitrios G. Oreopoulos & Christopher T. Chan

  3. Toronto General Hospital, 200 Elizabeth Street, 8N Room 842, Toronto, ON, M5G 2C4, USA

    Christopher T. Chan

Authors
  1. Ai-Hua Zhang
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  2. Joanne M. Bargman
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  3. Charmaine E. Lok
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  4. Eveline Porter
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  5. Maria Mendez
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  6. Dimitrios G. Oreopoulos
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  7. Christopher T. Chan
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Correspondence to Christopher T. Chan.

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Zhang, AH., Bargman, J.M., Lok, C.E. et al. Dialysis modality choices among chronic kidney disease patients: identifying the gaps to support patients on home-based therapies. Int Urol Nephrol 42, 759–764 (2010). https://doi.org/10.1007/s11255-010-9793-9

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  • DOI: https://doi.org/10.1007/s11255-010-9793-9

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