The effect of contraindications and patient preference on dialysis modality selection in ESRD patients in The Netherlands

Jager, Kitty J; Korevaar, Johanna C; Dekker, Friedo W; Krediet, Raymond T; Boeschoten, Elisabeth W; Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) Study Group,

doi:10.1053/j.ajkd.2003.12.051

« Previous Next »American Journal of Kidney Diseases
Volume 43, Issue 5 , Pages 891-899, May 2004

The effect of contraindications and patient preference on dialysis modality selection in ESRD patients in The Netherlands☆

Kitty J Jager, MD, PhD
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Address reprint requests to Kitty J. Jager, MD, PhD, Department of Medical Informatics, J2-254, Academic Medical Center, PO Box 22700, 1100 DE Amsterdam, The Netherlands
Johanna C Korevaar, PhD
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Friedo W Dekker, PhD
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
Raymond T Krediet, MD, PhD
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Elisabeth W Boeschoten, MD, PhD
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Hans Mak Renal Research Institute, Naarden, The Netherlands
Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) Study Group
- The NECOSAD Study Group: A.J. Apperloo, J.N.M. Barendregt, R.J. Birnie, M. Boekhout, W.H. Boer, E.F.H. van Bommel, H.R. Büller, F.Th. de Charro, C.J. Doorenbos, W.T. van Dorp, A. van Es, W.J. Fagel, G.W. Feith, C.F.M. Franssen, L.A.M. Frenken, J.A.C.A. van Geelen, W. Geerlings, P.G.G. Gerlag, J.P.M.C. Gorgels, W. Grave, R.M. Huisman, M.A. Jansen, K. Jie, W.A.H. Koning-Mulder, M.I. Koolen, T.K. Kremer Hovinga, A.T.J. Lavrijssen, A.W. Mulder, K.J. Parlevliet, J.B. Rosman, J.L.C.M. van Saase, M.J.M. Schonk, M.M.J. Schuurmans, P. Stevens, J.G.P. Tijssen, R.M. Valentijn, G. Vastenburg, C.A. Verburg, V.M.C. Verstappen, H.H. Vincent, and P. Vos.

Received 29 July 2003; received in revised form 16 December 2003; accepted 16 December 2003.

Abstract

Patients with end-stage renal disease (ESRD) who are about to start long-term dialysis therapy are faced with the question of modality choice. The aim of the current study is to determine the influence of different factors on long-term dialysis modality choice. As part of a large Dutch prospective multicenter study, the Netherlands Cooperative Study on the Adequacy of Dialysis, we consecutively included all new patients with ESRD. Nephrologists indicated the most important reason for the modality selection. Of 1,347 included patients, 36% (n = 483) had a contraindication to either peritoneal dialysis (PD) or hemodialysis (HD) therapy. Eighty percent (n = 386) of all contraindications were directed to PD therapy. The most frequently mentioned contraindication was a social one; ie, the expected incapability of patients to perform PD exchanges themselves. Patients with contraindications were older, had more comorbidity, and lived alone more often compared with patients without contraindications. In patients without contraindications (64%), modality choice was based on patient preference. Older age increased the odds of choosing HD, whereas receipt of predialysis care was associated with a lower preference for HD. Older age was associated with more contraindications to PD therapy and stronger patient preference for HD therapy. An elderly patient therefore was more likely to start with HD therapy. Results from the current study suggest that an increase in provision of predialysis care, in combination with a reduction in social contraindications to PD therapy, may be associated with an increase in likelihood of starting with PD therapy. In a time of an aging population, increasing demand on dialysis capacity, and limited amount of financial supplies, we may reconsider current strategies to provide future patients with ESRD the possibility to start with the dialysis modality they prefer.