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

Heaf, James ; Heiro, Maija ; Petersons, Aivars ; Vernere, Baiba ; Povlsen, Johan V ; Sørensen, Anette Bagger ; Clyne, Naomi LU orcid ; Bumblyte, Inge ; Zilinskiene, Alanta and Randers, Else , et al. (2021) In Clinical Kidney Journal 14(9). p.2064-2074
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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Clinical Kidney Journal
volume
14
issue
9
pages
2064 - 2074
publisher
Oxford University Press
external identifiers
  • pmid:34476093
  • scopus:85123678893
ISSN
2048-8505
DOI
10.1093/ckj/sfaa260
language
English
LU publication?
yes
additional info
© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA.
id
360e3bee-4dbc-44f7-a370-94b2a4dd7f39
date added to LUP
2021-10-22 19:27:42
date last changed
2024-06-14 19:34:06
@article{360e3bee-4dbc-44f7-a370-94b2a4dd7f39,
  abstract     = {{<p>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).</p><p>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.</p><p>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.</p><p>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.</p>}},
  author       = {{Heaf, James and Heiro, Maija and Petersons, Aivars and Vernere, Baiba and Povlsen, Johan V and Sørensen, Anette Bagger and Clyne, Naomi and Bumblyte, Inge and Zilinskiene, Alanta and Randers, Else and Løkkegaard, Niels and Ots-Rosenberg, Mai and Kjellevold, Stig and Kampmann, Jan Dominik and Rogland, Björn and Lagreid, Inger and Heimburger, Olof and Lindholm, Bengt}},
  issn         = {{2048-8505}},
  language     = {{eng}},
  number       = {{9}},
  pages        = {{2064--2074}},
  publisher    = {{Oxford University Press}},
  series       = {{Clinical Kidney Journal}},
  title        = {{Choice of dialysis modality among patients initiating dialysis : results of the Peridialysis study}},
  url          = {{http://dx.doi.org/10.1093/ckj/sfaa260}},
  doi          = {{10.1093/ckj/sfaa260}},
  volume       = {{14}},
  year         = {{2021}},
}