Treatment modality selection in 150 consecutive patients starting ESRD therapy

Area of Science:

• Nephrology
• Renal Replacement Therapy

Background:

• End-stage renal disease (ESRD) requires renal replacement therapy, with hemodialysis (HD) and peritoneal dialysis (PD) being primary options.
• Patient and physician factors influence the choice between HD and PD.

Purpose of the Study:

• To investigate the determinants of treatment modality selection between HD and PD in 150 consecutive ESRD patients.
• To analyze the reasons behind choosing HD versus PD.

Main Methods:

• Retrospective chart review of 150 patients initiating ESRD therapy at a single tertiary care university hospital.
• Treatment modality (HD or PD) was recorded at 6 weeks post-initiation, excluding patients transplanted or deceased before this period.

Main Results:

• Of 150 patients, 83 chose HD and 67 chose PD.
• Reasons for directed HD included social factors (20), ostomies (3), and unsuitable abdomens (6).
• Reasons for directed PD included cardiovascular disease (10), lack of vascular access (3), and geographical factors (1).
• Among 31 diabetic patients, 17 chose PD and 14 chose HD (social reasons, refusal, or unsuitable abdomen).
• Of 74 patients eligible for either modality, 50% chose PD and 50% chose HD.
• 15 patients opted for self-care HD, with 7 having prior HD experience.
• 11 patients were not informed about PD options.
• No gender preference was observed for PD versus HD.

Conclusions:

• Informed patients with a choice predominantly select self-care dialysis modalities (CAPD or self-care HD).
• Social and medical factors significantly impact the initial directed choice of dialysis modality.
• Ensuring comprehensive patient education regarding PD is crucial for informed decision-making.