TY - JOUR
T1 - Choice of dialysis modality among patients initiating dialysis
T2 - results of the Peridialysis study
AU - Heaf, James
AU - Heiro, Maija
AU - Petersons, Aivars
AU - Vernere, Baiba
AU - Povlsen , Johan V
AU - Sorensen, Anette Bagger
AU - Clyne, Naomi
AU - Bumblyte, Inge
AU - Zilinskiene, Alanta
AU - Randers, Else
AU - Lokkegaard, Niels
AU - Ots-Rosenberg, Mai
AU - Kjellevold, Stig
AU - Kampmann, Jan Dominik
AU - Rogland, Bjorn
AU - Lagreid, Inger
AU - Heimburger, Olof
AU - Lindholm, Bengt
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Background. In patients with end-stage kidney disease (ESKD), home dialysis offers socio-economic and health benefits compared with in-centre dialysis but is generally underutilized. We hypothesized that the pre-dialysis course and institutional factors affect the choice of dialysis modality after dialysis initiation (DI). Methods. The Peridialysis study is a multinational, multicentre prospective observational study assessing the causes and timing of DI and consequences of suboptimal DI. Clinical and biochemical data, details of the pre-dialytic course, reasons for DI and causes of the choice of dialysis modality were registered. Results. Among 1587 included patients, 516 (32.5%) were judged unsuitable for home dialysis due to contraindications [384 (24.2%)] or no assessment [106 (6.7%); mainly due to late referral and/or suboptimal DI] or death [26 (1.6%)]. Older age, comorbidity, late referral, suboptimal DI, acute illness and rapid loss of renal function associated with unsuitability. Of the remaining 1071 patients, 700 (65.4%) chose peritoneal dialysis (61.7%) or home haemodialysis (HD; 3.6%), while 371 (34.6%) chose in-centre HD. Somatic differences between patients choosing home dialysis and in-centre dialysis were minor; factors linked to the choice of in-centre dialysis were late referral, suboptimal DI, acute illness and absence of a ‘home dialysis first’ institutional policy. Conclusions. Given a personal choice with shared decision making, 65.4% of ESKD patients choose home dialysis. Our data indicate that the incidence of home dialysis potentially could be further increased to reduce the incidence of late referral and unplanned DI and, in acutely ill patients, by implementing an educational programme after improvement of their clinical condition.
AB - Background. In patients with end-stage kidney disease (ESKD), home dialysis offers socio-economic and health benefits compared with in-centre dialysis but is generally underutilized. We hypothesized that the pre-dialysis course and institutional factors affect the choice of dialysis modality after dialysis initiation (DI). Methods. The Peridialysis study is a multinational, multicentre prospective observational study assessing the causes and timing of DI and consequences of suboptimal DI. Clinical and biochemical data, details of the pre-dialytic course, reasons for DI and causes of the choice of dialysis modality were registered. Results. Among 1587 included patients, 516 (32.5%) were judged unsuitable for home dialysis due to contraindications [384 (24.2%)] or no assessment [106 (6.7%); mainly due to late referral and/or suboptimal DI] or death [26 (1.6%)]. Older age, comorbidity, late referral, suboptimal DI, acute illness and rapid loss of renal function associated with unsuitability. Of the remaining 1071 patients, 700 (65.4%) chose peritoneal dialysis (61.7%) or home haemodialysis (HD; 3.6%), while 371 (34.6%) chose in-centre HD. Somatic differences between patients choosing home dialysis and in-centre dialysis were minor; factors linked to the choice of in-centre dialysis were late referral, suboptimal DI, acute illness and absence of a ‘home dialysis first’ institutional policy. Conclusions. Given a personal choice with shared decision making, 65.4% of ESKD patients choose home dialysis. Our data indicate that the incidence of home dialysis potentially could be further increased to reduce the incidence of late referral and unplanned DI and, in acutely ill patients, by implementing an educational programme after improvement of their clinical condition.
KW - glomerular filtration rate
KW - haemodialysis
KW - peritoneal dialysis
KW - pre-dialysis
KW - uraemia
U2 - 10.1093/ckj/sfaa260
DO - 10.1093/ckj/sfaa260
M3 - Journal article
C2 - 34476093
SN - 2048-8505
VL - 14
SP - 2064
EP - 2074
JO - Clinical Kidney Journal
JF - Clinical Kidney Journal
IS - 9
ER -