Attitudes of Chinese chief nephrologists toward dialysis modality selection

Peritoneal dialysis (PD) is an effective renal replacement therapy; however, its penetration rate in China is rather low. In the present study, we investigated the opinions and attitudes of Chinese chief nephrologists about dialysis modality selection. We asked 51 chief nephrologists from various university hospitals to answer 8 questions about their attitudes toward PD and about the factors that affect their selection of dialysis modality. Hemodialysis (HD) was available in all of the hospitals where the surveyed chief nephrologists worked. Peritoneal dialysis was available in 68.6% of the hospitals, and renal transplantation was available in 54.9%. Of the surveyed nephrologists, 5.9% believed that PD was more advantageous than HD, and 29.4% of them believed that HD was better. However, most of the nephrologists (64.7%) thought that the advantages of each modality depended on the individual patient and therefore that modality selection should be individualized accordingly. About 70.6% of the nephrologists expressed confidence in PD, and 88% were interested in PD. Overall, 90.2% of the nephrologists said that they would start or expand a PD program in the future. More than half of the nephrologists (52.9%) thought that the proportion of PD in China should be 30%-50%. [The actual percentage is less than 10% in most ares (58.8%) of China.] Most nephrologists indicated that the major reasons for such low use of PD were the low profit from PD treatment and insufficient patient and professional education about PD. A few nephrologists said that peritonitis, the high PD dropout rate, and patient preference also affected the penetration of PD. Our findings suggest that many of the chief nephrologists in China are confident about PD treatment. The major obstacles to PD expansion in China are the lack of incentive (profit) for PD treatment and insufficient education for professionals and patients alike.