Attitudes of Canadian Nephrologists toward Dialysis Modality Selection

Abstract

Objective

To determine the opinions and attitudes of Canadian nephrologists about dialysis modality decisions and optimal dialysis system design.

Participants

Members of the Canadian Society of Nephrology.

Intervention

A mailed survey questionnaire.

Results

A 66% response rate was obtained. Decisions about modality are reported to be based most strongly on patient preference (4.4 on a scale from 1 to 5), followed by quality of life (4.06), morbidity (3.97), mortality (3.85), and rehabilitation (3.69), while neither facility (1.78) nor physician (1.62) reimbursement are important. When asked about the current relative utilization of each modality, nephrologists felt that hospital-based hemodialysis (HD) is slightly overutilized (2.53), continuous ambulatory peritoneal dialysis (CAPD) is about right (3.00), while cycler peritoneal dialysis (PD) (3.53), community-based full (3.83) and self-care HD (3.91), and home HD (4.02) are underutilized. A hypothetical question about optimal distribution to maximize survival revealed that a type of HD should constitute 62.8% of the mix, with more emphasis on cycler PD (14.9%), community-based full care HD (13.8%), self-care HD (14.5%), and home HD (9.0%) than is current practice. However, when the goal was to maximize cost effectiveness, HD fell slightly to 57.8%.

Conclusions

These survey results suggest that the current national average 66%/34% HD/PD ratio is reasonable. However, there appears to be a consensus that Canada could evolve to a more cost-effective, community-based dialysis system without compromising patient outcomes.

Keywords

End-stage renal disease ESRD hemodialysis dialysis modalities survey

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References

Kiberd

B.A.

Equitable allocation versus best outcome: competing economic and ethical strategies in renal transplantation.

Ann R Coll Surg Can 1992; 25: 446–8.

Fenton

S.S.A.

, Schaubel

, Desmeules

, Morrison

, Mao

, Copleston

Hemodialysis versus peritoneal dialysis: a comparison of adjusted mortality rates.

Am J Kidney Dis 1997; 30: 334–42.

Maiorca

, Cancarini

G.C.

, Zubani

, Camerini

, Manili

, Brunori

CAPD Viability: a long term comparison with hemodialysis.

Perit Dial Int 1996; 16: 276–87.

Held

P.J.

, Port

F.K.

, Turenne

M.N.

, Gaylin

D.S.

, Hamburger

R.J.

, Wolfe

R.A.

Continuous ambulatory peritoneal dialysis and hemodialysis: comparison of patient mortality with adjustment for comorbid conditions.

Kidney Int 1994; 45: 1163–9.

Bloembergen

W.E.

, Port

F.K.

, Mauger

E.A.

, Wolfe

R.A.

A comparison of mortality between patients treated with hemodialysis and peritoneal dialysis.

J Am Soc Nephrol 1995; 6: 177–83.

Keshaviah

P.R.

, Ma

, Thorpe

, Churchill

D.N.

, Collins

A comparison of 2 year survival on hemodialysis and peritoneal dialysis with a dose of dialysis matched using the peak concentration hypothesis.

J Am Soc Nephrol 1995; 6: 540A.

Goeree

, Manalich

, Grootendorst

, Beecroft

M.L.

, Churchill

D.N.

Cost analysis of dialysis treatments for end-stage renal disease (ESRD).

Clin Invest Med 1995; 18: 455–64.

Mendelssohn

D.C.

, for the CSN Professional, and Public Policy Committee. Principles of end stage renal disease care. Ann R Coll Surg Can 1997; 30: 271–3.

Mendelssohn

D.C.

, Chery

for the Toronto Region Dialysis Committee. Dialysis utilization in the Toronto region from 1981 to 1992. Can Med Assoc J 1994; 150: 1099–105.

10.

Kjellstrand

, Moody

Hemodialysis in Canada: a first class medical crisis.

Can Med Assoc J 1994; 150: 1067–71.

11.

Desmeules

, Schaubel

, Fenton

S.S.

, Mao

New and prevalent patients with end-stage renal disease in Canada. A portrait of the year 2000.

ASAIO J 1995; 41: 230–3.

12.

Port

F.K.

End-stage renal disease: magnitude of the problem, prognosis of future trends and possible solutions.

Kidney Int Suppl 1995; 50: S3–S6.

13.

Mattern

W.D.

, McGaghie

, Rigby

R.J.

, Nissenson

A.R.

, Dunham

, Khayrallah

M.A.

Selection of ESRD treatment: an international study.

Am J Kidney Dis 1989; 13: 457–64.

14.

Prichard

S.S.

Treatment modality selection in 150 consecutive patients starting ESRD therapy.

Perit Dial Int 1996; 16: 69–72.

15.

Nissenson

A.R.

, Prichard

S.S.

, Cheng

I.K.P.

Non-medical factors that impact on ESRD modality selection.

Kidney Int 1993; 43(Suppl 40): S120–7.

16.

Canadian Organ Replacement Register Annual Report 1997. Volume 1: Dialysis and renal transplantation. Ottawa: Canadian Institute for Health Information, 1997.

17.

United States Renal Data System. USRDS 1997 Annual Data Report. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 1997.

18.

Canadian Organ Replacement Register 1992 Ontario Report. Don Mills, ON: Canadian Institute for Health Information, 1994.

19.

Florakas

, Wilson

, Toffelmire

, Goodwin

, Morton

Differences in the treatment of male and female patients with end stage renal disease.

Can Med Assoc J 1994; 151: 1283–8.

20.

Canada–USA (CANUSA) Peritoneal Dialysis Study Group.

Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes.

J Am Soc Nephrol 1997; 7: 198–207.

21.

NKF-DOQI

Clinical practice guidelines for peritoneal dialysis adequacy.

Am J Kidney Dis 1997; 30(Suppl 3): S67–136.