Exploring Preconceptions as Barriers to Peritoneal Dialysis Eligibility: A Global Scenario-Based Survey of Kidney Care Physicians

Abstract

Introduction: Despite the growing number of patients requiring kidney replacement therapy (KRT), peritoneal dialysis (PD) is underutilized globally. A contributory factor may be clinician myths about its use. The aim of this study was to explore perceptions about PD initiation by clinicians according to various physical, social, and clinical characteristics of patients.

Methods: An online global survey (in English and Thai) was administered to ascertain nephrologists' and nephrology trainees' decisions on recommending PD as a treatment modality.

Results: A total of 645 participants (522 nephrologists and 123 trainees; 56% male) from 54 countries (66% from high-income countries [HICs], 22% from upper middle-income countries [UMICs], 12% from lower middle-income countries, and 1% from low-income countries [LICs]) completed the survey. Of the respondents, 81% identified as attending physicians or consultants, and 19% identified as trainees or other. PD was recommended for most scenarios, including repeated exposures to heavy lifting, swimming (especially in a private pool and ocean), among patients with cirrhosis or cognitive impairment with available support, and those living with a pet if a physical separation can be achieved during PD. Certain abdominal surgeries were more acceptable to proceed with PD (hysterectomy, 90%) compared to others (hemicolectomy, 45%). Similar variation was noted for different types of stomas (nephrostomies, 74%; suprapubic catheters, 53%; and ileostomies, 27%).

Conclusion: The probability of recommending PD in various scenarios was greater among clinicians from HICs, larger units, and consultants with more clinical experience. There is a disparity in recommending PD across various clinical scenarios driven by experience, unit-level characteristics, and region of practice. Globally, evidence-informed education is warranted to rectify misconceptions to enable greater PD uptake.

Keywords: kidney failure; nephrologist; patient selection; peritoneal dialysis; survey.

Graphical abstract

Figure 1

Physicians’ recommendations for swimming in bodies of water.

Figure 2

Physicians recommended peritoneal dialysis catheter exit site covering for water activities illustrating the colostomy bag as the main exit site covering.

Figure 3

Regional differences in kidney physicians offering peritoneal dialysis to a person with a body mass index of greater than 40 kg/m².

Figure 4

Responses by physicians to whether peritoneal dialysis would be offered to a person with multiple animals in a small apartment compared to if there was a separate dedicated peritoneal dialysis treatment room in the apartment.

Figure 5

Physicians’ responses to whether a person with the following medical history would be a suitable candidate for peritoneal dialysis.

Figure 6

Physicians offering peritoneal dialysis to people with either liver cirrhosis/ascites or polycystic kidney disease.

Figure 7

Physicians’ responses in recommending peritoneal dialysis for a patient on chronic immunosuppression and a patient who has had a failed transplant∗.

Figure 8

Percentage of physicians who would offer assisted peritoneal dialysis to a frail patient with cognitive impairment compared with unassisted peritoneal dialysis. PD, peritoneal dialysis.