Why Is the Evidence Favoring Hemodialysis over Peritoneal Dialysis Misleading? (original) (raw)
Related papers
Nephrology Dialysis Transplantation, 2008
Background. Peritoneal dialysis (PD) is underused in France compared with other countries. In addition, there are tremendous regional discrepancies concerning the utilization rate of PD. This study was carried out to evaluate the opinion of French nephrologists regarding the optimal rate of PD utilization and to determine which factors limit PD development in France. Methods. Of the 22 French regions, 2 regions with a high rate of PD utilization (prevalence >15%) and 3 regions with a low rate of PD utilization (prevalence <10%) were selected. In June 2007, nephrologists from the five regions were surveyed by questionnaire. Responses were compared between 'low-prevalence' and 'high-prevalence' groups. Results. The response rate was 70% and there was no significant difference between the two groups regarding the response rate. In the two groups, a majority of nephrologists were in charge of PD patients (30/34 in 'high-prevalence' group versus 61/80 in 'low-prevalence' group, P = 0.14). Information about PD in the predialysis clinics was provided by nephrologists from high-and low-prevalence regions (32/34 versus 65/80, P = 0.08). Opinions on the optimal rate of PD for prevalent and incident dialysis patients were significantly different between 'high-prevalence' and 'low-prevalence' groups [31 ± 15% versus 25 ± 14% (P < 0.03) and 25 ± 14% versus 19 ± 9% (P < 0.02)]. There was a significant difference concerning the optimal rate of PD in incident dialysis patients between nephrologists working in public centres (29 ± 15%), those working in non-profit clinics (27 ± 12%) and nephrologists working in the private sector (14 ± 8%). Lack of nurses available for the patient care (48%), low reimbursement of PD (25%), limited training (23%) and hospital care facilities (23%) were the main barriers limiting PD utilization.
Clinical Kidney Journal, 2013
Although peritoneal dialysis (PD) is recognized as an effective renal replacement therapy (RRT) alternative to haemodialysis (HD), its prevalence is around 15% in most of the industrialized countries. In the French-speaking part of Belgium, PD is clearly underused with a prevalence of 8.7% in 2009. The main objectives of this work were to evaluate the nephrologists' perceived obstacles to PD implementation and reflect on possible actions towards PD development. A computer-based 33-item questionnaire was sent by e-mail to all nephrologists affiliated to the French-speaking association. Among 120 adult nephrologists targeted by this inquiry, 97 completed the online questionnaire (response rate 80.8%). Among them, 29% had little experience with PD (treating less than five patients) and 39% reported no specific training with this modality of RRT. However, 88% of responders claimed PD prevalence should be around 20-25%. Half of the responders would choose PD as a first RRT option if they required RRT for themselves. The three main reasons given to the low prevalence of PD were an easy access to HD, patient refusal and lack of nephrologist motivation. Almost all the nephrologists insisted on the need for a dedicated nursing team delivering an effective educational programme and PD management and care. They believe that PD could and should be implemented in Belgium. Enhanced nephrologist motivation and training in PD were identified as predominant factors to be upgraded, as well as patient education programmes.
Bulletin de la dialyse à domicile, 2020
A renewed interest in home hemodialysis (HHD) has emerged in recent years, brought about by the availability of new dialysis machines and encouraging research about daily hemodialysis (HD). Since 2013, the RDPLF, a home dialysis registry, has recorded the data of patients treated with peritoneal dialysis (PD) and those treated with HHD, regardless of technique. Through this organization, nine Belgian centers and fifty-seven French centers communicate information about their patients treated by hemodialysis at home. According to RDPLF, 56% of Belgian HHD patients are treated with daily hemodialysis, while in France 83% of home patients are on daily dialysis. This large number in France, however, is not representative of the whole country but can be explained through the recruitment of new centers already involved in PD and convinced by the interest in continuous daily treatment. In both countries, 13% of HHD patients were previously treated with PD, with an interim period of in-center HD or transplantation. The median duration of in-center HD is 10 months, with extremes ranging from 2 months to 25 years. PD patients treated secondarily through HHD are mainly young, non-diabetic, and independent patients. Early information about patients who have a risk of PD failure and the provision of materials supporting both techniques would reduce or abolish a transient transfer to in-center HD and ensure home care in patients who desire it.
Availability of assisted peritoneal dialysis in Europe: call for increased and equal access
Nephrology Dialysis Transplantation
Introduction Availability of assisted PD (asPD) increases access to dialysis at home, particularly for the increasing numbers of older and frail people with advanced kidney disease. Although asPD has been widely used in some European countries for many years, it remains unavailable or poorly utilised in others. A group of leading European nephrologists have therefore formed a group to drive increased availability of asPD in Europe and in their own countries. Methods Members of the group filled in a proforma with the following headings: personal experience, country experience, who are the assistants, funding of asPD, barriers to growth, what is needed to grow, and their top 3 priorities. Results Only 5 of the 13 countries surveyed provided publicly funded reimbursement for asPD. The use of asPD depends on overall attitudes to PD with all respondents mentioning need for nephrology team education and/or patient education and involvement in dialysis modality decision making. Conclusion ...
Barriers and opportunities to increase PD incidence and prevalence: Lessons from a European Survey
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Introduction: Peritoneal dialysis (PD) remains underutilised and unplanned start of dialysis further diminishes the likelihood of patients starting on PD, although outcomes are equal to haemodialysis (HD). Methods: A survey was sent to members of EuroPD and regional societies presenting a case vignette of a 48-year-old woman not previously known to the nephrology department and who arrives at the emergency department with established end-stage kidney disease (unplanned start), asking which dialysis modality would most likely be chosen at their respective centre. We assessed associations between the modality choices for this case vignette and centre characteristics and PD-related practices. Results: Of 575 respondents, 32.8%, 32.2% and 35.0% indicated they would start unplanned PD, unplanned HD or unplanned HD with intention to educate patient on PD later, respectively. Likelihood for unplanned start of PD was only associated with quality of structure of the pre-dialysis program. Str...
Opinions regarding outcome differences in European and US haemodialysis patients
Nephrology Dialysis Transplantation, 1999
ably different in terms of age, ethnological characteristics, underlying renal diseases and co-morbidities Study goal and design. The aim of this evaluation was to understand why outcomes seem to be different in [2-5]. Since 'The Morbidity, Mortality and Prescription of different parts of the world. In an attempt to look at this question from a point of view other than that Dialysis Symposium' held in Dallas in 1989, it has become increasingly clear that the US mortality rate necessarily adopted by epidemiological studies, we decided to explore the personal opinion of a selected among dialysis patients (over 20 per 100 patient-years) is relatively high [2-5]. Despite various strategies for group of American (US) and European (EU) experts by means of a simple questionnaire. A 13-item ques-influencing outcomes suggested by the United States Renal Data System (USRDS), this mortality rate has tionnaire was sent to 14 internationally recognized opinion leaders in the field of haemodialysis: all seven decreased only slightly [3]. In contrast, the reported mortality rates in other Europeans and five of the seven Americans responded. The answers to each question were stratified in order Western countries are lower-even as low as 10 per 100 patient-years [4]. This striking difference is explained to highlight the key differences between the experts in the different continents. partly on the basis of patient characteristics (age, diabetes, gender, ethnological characteristics, etc.), but Results. Ten of the 12 respondents (six EU and four US) said that dialysis outcomes are better in Europe; may also be due to differences in treatment and/or the level of reliability of the various dialysis registries [6 ]. nine (six EU and three US) confirmed their opinion after taking patient characteristics into account. When However, as Dr Philip Held has recently pointed out ('Strategies for influencing outcomes in pre-ESRD asked to suggest reasons for this difference, the highest score was given to the quality of procedures and and ESRD patients' meeting, Washington DC, 1998), we should avoid excessive chauvinism when interpret-medical training with no differences between EU and US physicians. This was followed by three other factors ing these figures; it is more important simply to understand why outcomes seem to be different in different that received the same overall score (financial issues, doctor bedside time and quality of pre-dialysis care), parts of the world [7]. In an attempt to look at this question from a point but it is interesting to note that the Europeans attributed considerably greater importance to bedside time of view other than that necessarily adopted by epidemiological studies, we decided to explore the personal than their US counterparts. Conclusion. It seems that the reported difference in opinion of a selected group of American (US) and European (EU) experts by means of a simple dialysis outcomes between Europe and the US is a widely accepted fact. Although directed towards few questionnaire. respondents, our questionnaire does suggest some differences in the approach towards dialysis and endstage renal disease patients. Methods The 13-item questionnaire was sent to 14 internationally
Comparison of hemodialysis and peritoneal dialysis survival in The Netherlands
Kidney International, 2007
Considerable geographic variation exists in the relative use of hemodialysis (HD) vs peritoneal dialysis (PD). Studies comparing survival between these modalities have yielded conflicting results. Our aim was to compare the survival of Dutch HD and PD patients. We developed Cox regression models using 16 643 patients from the Dutch End-Stage Renal Disease Registry (RENINE) adjusting for age, gender, primary renal disease, center of dialysis, year of start of renal replacement therapy, and included several interaction terms. We assumed definite treatment assignment at day 91 and performed an intention-to-treat analysis, censoring for transplantation. To account for time dependency, we stratified the analysis into three time periods, 43-6, 46-15, and 415 months. For the first period, the mortality hazard ratio (HR) of PD compared with HD patients was 0.26 (95% confidence interval (CI) 0.17-0.41) for 40-year-old nondiabetics, which increased with age and presence of diabetes to 0.95 (95% CI 0.64-1.39) for 70-year-old patients with diabetes as primary renal disease. The HRs of the second period were generally higher. After 15 months, the HR was 0.86 (95% CI 0.74-1.00) for 40-year-old non-diabetics and 1.42 (95% CI 1.23-1.65) for 70-year-old patients with diabetes as primary renal disease. We conclude that the survival advantage for Dutch PD compared with HD patients decreases over time, with age and in the presence of diabetes as primary disease.
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Background: In Europe, the number of elderly end-stage kidney disease patients is increasing. Few of those patients receive peritoneal dialysis (PD), as many cannot perform PD autonomously. Assisted PD programmes are available in most European countries, but the percentage of patients receiving assisted PD varies considerably. Hence, we assessed which factors are associated with the availability of an assisted PD programme at a centre level and whether the availability of this programme is associated with proportion of home dialysis patients. Methods: An online survey was sent to healthcare professionals of European nephrology units. After selecting one respondent per centre, the associations were explored by χ 2 tests and (ordinal) logistic regression. Results: In total, 609 respondents completed the survey. Subsequently, 288 respondents from individual centres were identified; 58% worked in a centre with an assisted PD programme. Factors associated with availability of an assisted...
PLOS ONE, 2016
d.PD Clinics Eastern Europe and JCDF (previously working at Diaverum with same affiliation as BM). At the time of manuscript submission, JCDF is affiliated to CLINTEC. ARQ is affiliated to CLINTEC but worked on his free time. Neither Diaverum nor CLINTEC had any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. adjustment for age and gender. "Optimal care," defined as ICS follow-up >12 months plus modality information and P start, occurred in 23%. Conclusions Despite the high rate of late referrals, information and education were widely provided. However, NP start was high and related to late referral and may explain the low frequency of PD.