Perceptions about renal replacement therapy among nephrology professionals

Abstract

Usage of renal replacement modalities available for the treatment of end stage renal disease varies widely between countries, indicating that non-medical factors contribute to the choice of therapy. In the United States, 93% of the patients are treated with in-center hemodialysis (HD), about 7% undergo peritoneal dialysis (PD) and less than 1% are on home HD. In comparison, a Northern California-based nonprofit dialysis provider with home dialysis centers throughout the United States has achieved a home therapy penetration of 22%, the highest proportion of home therapies among U.S. dialysis providers. To better understand the perceptions about the various modality choices among caretakers (nephrologists and nurses) in this organization a short questionnaire was used. We examined the hypothetical setting of the caretakers being in the patient role. More than 90% of the nephrology professionals chose a home therapy as initial treatment option with close to equal distribution between PD and home HD. This pattern persisted for maintenance therapy with home HD being the preferred modality. Nephrologists' and nurses' perception of who makes modality decisions varied profoundly.