Treatment Modality Selection in 150 Consecutive Patients Starting Esrd Therapy

Abstract

Objective The purpose of this study was to assess the reasons for treatment modality selection between hemodialysis (HD) and peritoneal dialysis (PD) in 150 consecutive patients in a single center. Design This study is a retrospective study using chart review as the data collection method. Setting A single tertiary care university teaching hospital. Patients One hundred and fifty consecutive patients starting end-stage renal disease (ESRD) therapy at the Royal Victoria Hospital in Montreal were assessed. Their treatment modality at 6 weeks after starting dialysis was recorded as their treatment modality. Patients transplanted or who died prior to that 6 week period were excluded. Main Outcome Measures The treatment modality, that is, either HD or PD, at 6 weeks after the initiation of ESRD was the modality assigned to the patient. Results One hundred and fifty patients started ESRD therapy of whom 83 went to HD and 67 to PD. Thirty-one patients were directed to HD, including 20 for social reasons, 3 with ostomies, and 6 with unsuitable abdomens. Fourteen patients were directed to PD, including 10 with severe cardiovascular disease, 3 with no vascular access, and one for geographical reasons. Of 31 diabetics who were encouraged to do PD, 17 went to PD and 14 to HD (10 for social reasons, 3 refused PD, and one with an inappropriate abdomen). Seventy-four patients were initially eligible for either PD or HD. Fifty percent (37) went to PD and 50% to HD. Of those going to HD, 15 went to self-care HD, of whom 7 had prior exposure to HD. Eleven were not informed regarding PD. There was no gender preference for PD versus HD. Conclusion We conclude that among informed patients, if given a choice of treatment modality, the majority will choose self-care dialysis including continuous ambulatory peritoneal dialysis (CAPD) or selfcare HD.