Perceptions about the dialysis modality decision process among peritoneal dialysis and in-center hemodialysis patients

Abstract

Background: Patients reaching end-stage renal disease must make a difficult decision regarding renal replacement therapy (RRT) options. Because the choice between dialysis modalities should include patient preferences, it is critical that patients are engaged in the dialysis modality decision. As part of the Empowering Patients on Choices for RRT (EPOCH-RRT) study, we assessed dialysis patients' perceptions of their dialysis modality decision-making process and the impact of their chosen modality on their lives.

Methods: A 39-question survey was developed in collaboration with a multi-stakeholder advisory panel to assess perceptions of patients on either peritoneal dialysis (PD) or in-center hemodialysis (HD). The survey was disseminated to participants in the large US cohorts of the Dialysis Outcomes and Practice Patterns Study (DOPPS) and the Peritoneal DOPPS (PDOPPS). Survey responses were compared between PD and in-center HD patients using descriptive statistics, adjusted logistic generalized estimating equation models, and linear mixed regression models.

Results: Six hundred fourteen PD and 1346 in-center HD participants responded. Compared with in-center HD participants, PD participants more frequently reported that they were engaged in the decision-making process, were provided enough information, understood differences between dialysis modalities, and felt satisfied with their modality choice. PD participants also reported more frequently than in-center HD participants that partners or spouses (79% vs. 70%), physician assistants (80% vs. 66%), and nursing staff (78% vs. 60%) had at least some involvement in the dialysis modality decision. Over 35% of PD and in-center HD participants did not know another dialysis patient at the time of their modality decision and over 60% did not know the disadvantages of their modality type. Participants using either dialysis modality perceived a moderate to high impact of dialysis on their lives.

Conclusions: PD participants were more engaged in the modality decision process compared to in-center HD participants. For both modalities, there is room for improvement in patient education and other support for patients choosing a dialysis modality.

Keywords: Dialysis modality; End-stage renal disease; Hemodialysis; Peritoneal dialysis; Renal replacement therapy.

Fig. 1

Recruitment of Study Participants

Fig. 2

Involvement of family and peers in the dialysis modality decision. Patients who reported not applicable (range: 3% for nephrologist to 35% for peer and 47% for adult child/children) were excluded from the relevant question. *Adjusted differences in the degree of involvement of family members and peers between PD and in-center HD patients. Estimates from linear mixed regression models adjusted for age, sex, black race, time on dialysis, and diabetes, and accounting for facility clustering

Fig. 3

Patients’ self-reported experience and satisfaction with the dialysis modality decision. *Difference in probability and 95% confidence interval (CI) of agreement with each statement comparing PD vs. in-center HD. Estimates from logistic GEE model adjusted for age, sex, black race, time on dialysis, and diabetes, and accounting for facility clustering. Adjusted differences in predicted probabilities were calculated for a white, non-diabetic male of average age and average vintage

Fig. 4

Effect of dialysis on patient-centered outcomes. Patients who reported not applicable (range: 1% to 9%) were excluded from the relevant question. * Difference in probability and 95% confidence interval (CI) of a large impact of dialysis on each factor comparing PD vs. in-center HD. Estimates from logistic GEE model adjusted for age, sex, black race, time on dialysis, and diabetes, and accounting for facility clustering. Adjusted differences in predicted probabilities were calculated for a white, non-diabetic male of average age and average vintage