Dialysis choice in the context of an early referral policy: there is room for self care.
BACKGROUND
Predialysis care is vital for the patient and is crucial for dialysis choice: empowered, early referred patients tend to prefer out-of-hospital and self-care treatment; despite these claims, early referral remains too often a program more than a reality. Aim of the study was to evaluate the pattern and reasons for RRT choice in patients treated in a long-standing outpatient network, presently following 850 chronic patients (about 80% diabetics), working with an early referral policy and offering a wide set of dialysis options (home hemo and PD; self care and limited care hemodialysis; hospital hemodialysis).


METHODS
Prospective historical study. All patients who started RRT in January 2001-December 2003 were considered. Correlations between demographical (sex, age, educational level) or clinical variables (pre-RRT follow-up, comorbidity, SGA and Karnofsky) and treatment choice have been tested by univariate (chi-square, Kruskal-Wallis) and multivariate models (logistic regression), both considering all choices and dichotomising choice into "hospital" versus "out of hospital dialysis".


RESULTS
Hospital dialysis was chosen by 32.6% of patients; out of hospital in 67.4% (PD 26.5%, limited-care 18.4%, home hemodialysis 4.1%, self-care 18.4%). Hospital dialysis and PD were chosen by elderly patients (median age: 67.5 and 70 years respectively) with multiple comorbidities (75% and 92.3%); no difference for age, comorbidity, Karnofsky, SGA and educational level. 6/13 PD patients needed the help of a partner. Self-care/home hemodialysis patients were younger (median age 52), had higher educational level (p = 0.014) and lower prevalence of comorbidity (63.6% vs 94.7% in the other dialysis patients, p = 0.006). In the context of a long follow-up period (3.9 years) a statistically significant difference was found comparing hospital dialysis (3.3 years) vs out of hospital dialysis (4.9 years) (p = 0.035). In a logistic regression model, only pre-RRT follow-up was correlated with dialysis "hospital vs "out of hospital" choice (p = 0.014).


CONCLUSIONS
Early nephrological follow-up may enhance self and home-based dialysis care.
Piccoli
Giorgina B
GB
Department of Internal Medicine, University of Torino, Torino, Italy. gbpiccoli@hotmail.com
Mezza
Elisabetta
E
Burdese
Manuel
M
Consiglio
Valentina
V
Vaggione
Silvia
S
Mastella
Claudia
C
Jeantet
Alberto
A
Maddalena
Emanuela
E
Martina
Guido
G
Gai
Massimo
M
Motta
Daria
D
Segoloni
Giuseppe Paolo
GP
Piccoli
Giuseppe
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006437:Hemodialysis, Home / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010353:Patient Education as Topic; D010530:Peritoneal Dialysis / Q000379:methods / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012017:Referral and Consultation; D012648:Self Care / Q000379:methods / Q000706:statistics & numerical data*