Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec 24;14(9):2064-2074.
doi: 10.1093/ckj/sfaa260. eCollection 2021 Sep.

Choice of dialysis modality among patients initiating dialysis: results of the Peridialysis study

James Heaf  1   2 , Maija Heiro  3 , Aivars Petersons  4 , Baiba Vernere  4 , Johan V Povlsen  5 , Anette Bagger Sørensen  5 , Naomi Clyne  6 , Inge Bumblyte  7 , Alanta Zilinskiene  7 , Else Randers  8 , Niels Løkkegaard  9 , Mai Ots-Rosenberg  10 , Stig Kjellevold  11 , Jan Dominik Kampmann  12 , Björn Rogland  13 , Inger Lagreid  14 , Olof Heimburger  15 , Bengt Lindholm  15
Affiliations

Choice of dialysis modality among patients initiating dialysis: results of the Peridialysis study

James Heaf et al. Clin Kidney J. .

Abstract

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.

Keywords: glomerular filtration rate; haemodialysis; peritoneal dialysis; pre-dialysis; uraemia.

PubMed Disclaimer

Figures

FIGURE 1:
FIGURE 1:
Distribution of stated causes of modality choice.
FIGURE 2:
FIGURE 2:
Relationship of pre-dialysis factors to choice of modality. The percentage figures refer to the percentage of patients in each modality choice group with the relevant factor.
FIGURE 3:
FIGURE 3:
Putative causal mechanisms affecting modality choice. Uraemia: high plasma urea.
See this image and copyright information in PMC

References

    1. Heaf JG, Wehberg S.. Relative survival of peritoneal dialysis and haemodialysis patients: effect of cohort and mode of dialysis initiation. PLoS One 2014; 9: e90119. - PMC - PubMed
    1. Weinhandl ED, Foley RN, Gilbertson DT. et al.Propensity-matched mortality comparison of incident hemodialysis and peritoneal dialysis patients. J Am Soc Nephrol 2010; 21: 499–506 - PMC - PubMed
    1. Quinn RR, Hux JE, Oliver MJ. et al.Selection bias explains apparent differential mortality between dialysis modalities. J Am Soc Nephrol 2011; 22: 1534–1542 - PMC - PubMed
    1. Mehrotra R, Chiu YW, Kalantar-Zadeh K. et al.Similar outcomes with hemodialysis and peritoneal dialysis in patients with end-stage renal disease. Arch Intern Med 2011; 171: 110–118 - PubMed
    1. Noordzij M, Jager KJ.. Survival comparisons between haemodialysis and peritoneal dialysis. Nephrol Dial Transplant 2012; 27: 3385–3387 - PubMed