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Appropriateness of the dialysis modality selection process: A cross-sectional study
Karla Salas-Gama1,2,3,4, Juan-Manuel Díaz-Gómez5,6, Ignasi Bolíbar Ribas4,7,8
1Quality, Process and Innovation Direction, Valld'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
Medicine
|October 25, 2022
Summary
Many patients undergoing dialysis may not have had the most appropriate treatment selected. Improving information and shared decision-making could double the use of peritoneal dialysis (PD) over hemodialysis (HD).
Area of Science:
- Nephrology
- Renal Replacement Therapy
- Healthcare Quality Improvement
Background:
- Dialysis modality selection is crucial for patient outcomes.
- Peritoneal dialysis (PD) offers benefits but may be underutilized compared to hemodialysis (HD).
- Quantifying the appropriateness of dialysis selection is currently lacking.
Purpose of the Study:
- To assess the appropriateness of dialysis modality selection processes.
- To quantify the proportion of patients who could have been suitable candidates for PD.
- To identify factors influencing inappropriate dialysis selection.
Main Methods:
- Cross-sectional study of adult patients initiating dialysis (2014-2015) at a Barcelona Nephrology Department.
- Assessment of selection appropriateness across three domains: eligibility, information provision, and shared decision-making.
- Data collected via medical records and patient questionnaires.
Main Results:
- The selection process was potentially inappropriate in 22% of 141 patients.
- Information deficits (15%) and shared decision-making issues (7%) were key factors.
- Appropriate PD use could potentially increase from 17% to 38%.
Conclusions:
- Significant opportunities exist to improve dialysis modality selection.
- Enhanced patient education and shared decision-making can substantially increase PD utilization.
- This appropriateness analysis provides a framework for optimizing renal replacement therapy strategies.
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