Nephrologists' perspectives on dialysis treatment: results of an international survey

Abstract

Background: In-centre haemodialysis (ICHD) is the most common dialysis method used by patients worldwide. However, quality of life and clinical outcomes in patients treated via ICHD have not improved for some time. 'High-dose' haemodialysis (HD) regimens--which are longer and/or more frequent than conventional regimens and are particularly suitable to delivery in the home--may offer a route to improved outcomes and quality of life. This survey aimed to determine nephrologists' views on the validity of alternatives to ICHD, particularly home HD and high-dose HD.

Methods: A total of 1,500 nephrologists from Europe, Canada and the United States were asked to respond to an online questionnaire that was designed following previous qualitative research. Certified nephrologists in practice for 2-35 years who managed >25 adult dialysis patients were eligible to take part.

Results: A total of 324 nephrologists completed the survey. ICHD was the most common type of dialysis used by respondents' current patients (90%), followed by peritoneal dialysis (8%) and home HD (2%). The majority of respondents believed that: home HD provides better quality of life; increasing the frequency of dialysis beyond three times per week significantly improves clinical outcomes; and longer dialysis sessions performed nocturnally would result in significantly better clinical outcomes than traditional ICHD.

Conclusions: Survey results indicated that many nephrologists believe that home HD and high-dose HD are better for the patient. However, the majority of their patients were using ICHD. Education, training and support on alternative dialysis regimens are needed.

Figure 1

Proportion of patients receiving different forms of dialysis treatment by country. HHD, home haemodialysis; ICHD, in-centre haemodialysis; PD, peritoneal dialysis, n = number of respondents per country.

Figure 2

Nephrologists’ attitudes towards different dialysis modalities. Responses to statements around the effects of different dialysis modalities on (A) quality of life and (B) clinical outcomes. HHD, home haemodialysis; QoL, quality of life; ICHD, in-centre haemodialysis; PD, peritoneal dialysis.

Figure 3

Nephrologists’ dialysis recommendations to patients in fictional case studies. (A) Patient has relatively good health and is new to dialysis; (B) Patient has relatively poor health and is already on ICHD. HHD, home haemodialysis; ICHD, in-centre haemodialysis; PD, peritoneal dialysis. *Self-care HD = patients attend outpatient facilities with no/very limited nurse supervision and no attending doctor (France only).