メキシコの大規模医療機関におけるリアルワールドでの透析療法選択：多施設共同横断研究

Although current clinical practice guidelines recommend shared decision-making among patients, families, and healthcare teams, the process remains insufficiently understood in real-world practice. This study analyzed the criteria that guide dialysis modality selection among patients undergoing renal replacement therapy (RRT) at the Instituto Mexicano del Seguro Social (IMSS).

A cross-sectional, multicenter study was conducted with 958 patients who initiated dialysis. Data on demographics, clinical characteristics, dialysis settings, prescriptions, and participation in modality choice were collected and analyzed.

Of the 958 patients, 26.2% were on automated peritoneal dialysis (APD), 34.2% on continuous ambulatory peritoneal dialysis (CAPD), and 39.5% on hemodialysis (HD). CAPD patients were older, and more frequently female and diabetic. They also had lower education levels and income. In contrast, APD patients were predominantly male with higher education levels and income. Chronic kidney disease (CKD) was diagnosed more frequently, with a faster transition to PD. Patients on HD were less informed and trained than those on PD. Of the patients that participated in the selection of the modality of dialysis, 64.1% were on APD, 66.0% on CAPD, and 47.7% on HD. Dependence on caregivers was lowest in APD and highest in CAPD. HD patients experienced longer travel times and used more expensive private transportation.

Patients are assigned to dialysis modalities according to an a priori criteria considered by dialysis committees, such as independence, clinical condition, and socioeconomic level. However, among patients starting RRT in private hospitals, the IMSS clinical practice guidelines are not consistently followed, particularly for those assigned to HD. Whether each modality offers real-world advantages in terms of survival or cost-effectiveness remains to be determined.