Psychosocial Burdens of Dialysis Treatment Modalities: Do They Differ and Does it Matter?

There have been changes and developments in recent years in the types of dialysis available for children. In particular, there has been an increasing use of continuous ambulatory peritoneal dialysis (CAPD) and a decrease in the number of children receiving home-based hemodialysis (HD). In the United Kingdom in 1992, 21% of children being treated for end-stage renal failure (ESRF) were receiving CAPD or continuous cycling peritoneal dialysis (CCPD) at home; 0.4% were on home HD and 9.5% were maintained on hospital HD; 69% had functioning transplants (1). However, children with ESRF are involved in a cycle of treatment and may change their method of dialysis several times during child hood. There is an increasing trend for this pattern, particularly as children are starting renal replacement therapy (RRT) younger, with more years of dialysis and transplantation ahead of them, probably followed by a return to dialysis.

Important differences occur in the use of different dialysis treatment modalities in various countries. Differences in availability may reflect such things as economic constraints or other resource issues. Professional expertise or preferences within individual units may also be factors that affect the types of dialysis that are offered to children.

Physical and economic factors apart, what other considerations may affect the choice of dialysis modality in individual cases? How important are psychosacial factors in relation to such decisions? Is one modality better or worse than another when it comes to psychological or social outcome? Which causes a greater burden for children and their families -hospital or home-based dialysis, HD or peritoneal dialysis (PD), CCPD or CAPD? If we can predict, how far can or should psychosocial factors affect the choice of treatment for children?