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

Autor: Heaf J; Department of Medicine, Zealand University Hospital, Roskilde, Denmark.; Department of Nephrology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark., Heiro M; Department of Medicine, Turku University Hospital, Turku, Finland., Petersons A; Latvia Nephrology Department, P. Stradins University Hospital, Riga, Latvia., Vernere B; Latvia Nephrology Department, P. Stradins University Hospital, Riga, Latvia., Povlsen JV; Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark., Sørensen AB; Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark., Clyne N; Department of Nephrology, Clinical Sciences Lund, Lund University, Skåne University Hospital, Malmö, Sweden., Bumblyte I; Nephrological Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania., Zilinskiene A; Nephrological Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania., Randers E; Department of Medicine, Viborg Regional Hospital, Viborg, Denmark., Løkkegaard N; Department of Medicine, Holbaek Hospital, Holbaek, Denmark., Ots-Rosenberg M; Department of Nephrology, University Hospital of Tartu, Tartu, Estonia., Kjellevold S; Department of Medicine, Vestfold Hospital, Tønsberg, Norway., Kampmann JD; Department of Nephrology, Hospital of Southern Jutland, Soenderborg, Denmark., Rogland B; Department of Medicine, Kristianstad Hospital, Kristianstad, Sweden., Lagreid I; Department of Medicine, St Olav University Hospital, Trondheim, Norway., Heimburger O; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden., Lindholm B; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Jazyk: angličtina
Zdroj: Clinical kidney journal [Clin Kidney J] 2020 Dec 24; Vol. 14 (9), pp. 2064-2074. Date of Electronic Publication: 2020 Dec 24 (Print Publication: 2021).
DOI: 10.1093/ckj/sfaa260
Abstrakt: 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.
(© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA.)
Databáze: MEDLINE
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