Perspectives on Peritoneal Dialysis and Kidney Transplant in Adolescents and Young Adults: A Qualitative Study

Peritoneal dialysis and kidney transplantation confer better quality of life than hemodialysis, but uptake is low in adolescents and young adults. Our objective was to explore perspectives on peritoneal dialysis and living donor kidney transplantation among adolescents and young adults with chronic kidney disease.

A qualitative study using semistructured interviews.

Thirteen adolescents and young adults with nondialysis-dependent chronic kidney disease and 10 of their parents were recruited from a single academic medical center in the San Francisco Bay Area, California, United States.

Interview transcripts were analyzed qualitatively to identify prevalent themes.

Perspectives on peritoneal dialysis included the following: (1) lack of awareness of peritoneal dialysis as a treatment option; (2) negative impressions of dialysis based on anecdotes from people receiving hemodialysis; and (3) infectious concerns regarding home dialysis. Perspectives on living donor kidney transplantation included the following: (1) resistance to an illness-centered identity; (2) misperception and confusion regarding the waitlisting process; (3) "heavy guilt": the burden of responsibility for adverse outcomes after directed donation; and (4) ensuring living donor availability for the future. An overlapping theme of reliance on mothers for chronic kidney disease caregiving and potential donation was also identified.

This single-center study included patients referred to 1 kidney transplant center, and findings may be context specific.

Adolescents and young adults with chronic kidney disease and their parents had low awareness of peritoneal dialysis and low levels of engagement in the search for donors. Some barriers were unique to this population and differed from those previously identified among older adults with kidney failure. Providers should be aware of these differences when counseling this younger population on kidney replacement therapy options.