Real-World Dialysis Modality Selection in a Global Mexican Institution: A Multicenter Cross-Sectional Study.

Area of Science:

• Nephrology
• Public Health
• Health Services Research

Background:

• Clinical practice guidelines advocate for shared decision-making in dialysis modality selection, but real-world application is poorly understood.
• This study investigates the criteria influencing dialysis modality choice for patients undergoing renal replacement therapy (RRT) at the Instituto Mexicano del Seguro Social (IMSS).

Purpose of the Study:

• To analyze the criteria guiding dialysis modality selection among RRT patients in a large Mexican healthcare system.
• To assess patient participation in modality choice and compare characteristics across different dialysis types.

Main Methods:

• A cross-sectional, multicenter study involving 958 patients initiating dialysis.
• Data collected included demographics, clinical characteristics, dialysis settings, prescriptions, and modality choice participation.

Main Results:

• Patient distribution: 26.2% automated peritoneal dialysis (APD), 34.2% continuous ambulatory peritoneal dialysis (CAPD), 39.5% hemodialysis (HD).
• Demographic and clinical differences observed: CAPD patients were older, more frequently female and diabetic with lower socioeconomic status; APD patients were predominantly male with higher socioeconomic status.
• Patients on HD were less informed and trained, experienced longer travel times, and used more expensive transportation compared to PD patients. Caregiver dependence was lowest in APD and highest in CAPD.

Conclusions:

• Dialysis committees assign modalities based on pre-defined criteria like independence, clinical condition, and socioeconomic level.
• IMSS clinical practice guidelines are not consistently followed, especially for hemodialysis patients in private hospitals.
• The real-world survival and cost-effectiveness advantages of each dialysis modality require further investigation.