title: Starting and withdrawing haemodialysis--associations between nephrologists' opinions, patient characteristics and practice patterns (data from the Dialysis Outcomes and Practice Patterns Study).
abstract: BACKGROUND
  The incidence and prevalence of haemodialysis vary widely across countries. The variation may be attributable to differences in the incidence of end-stage renal disease and/or in the availability of haemodialysis. Previous studies have identified differences in nephrologists' opinions about the availability of haemodialysis and its appropriateness for patients with comorbidities. We studied the associations between nephrologists' opinions, availability of haemodialysis, patient characteristics and comorbidities, and facilities' withdrawal rates.
  
  
  METHODS
  Most of our analyses used data from 242 haemodialysis units in six countries (France, Germany, Italy, Spain, UK and the USA) in the first phase of the Dialysis Outcomes and Practice Patterns Study (DOPPS I). Opinions about access to and practice patterns in dialysis facilities, measured by the level of agreement with standardized statements, were collected from medical directors and nurse managers. A sub-analysis considered data from corresponding facilities in DOPPS II.
  
  
  RESULTS
  We found wide variations in the prevalence of waiting lists for new dialysis patients (UK 60%; USA 25%; Germany 0%; P < 0.05), in agreement with starting haemodialysis for patients with advanced age, dementia and comorbidities (UK, France < USA < other countries; P < 0.05), and in agreement with withdrawing dialysis (other countries < UK/USA; P < 0.05). The estimated glomerular filtration rate at the start of dialysis was not significantly different in units with waiting lists. Significant associations were found between nephrologists' opinions and the odds of patients being > or =80 years old, and between opinions and the rate and relative risk of withdrawal of haemodialysis. No significant associations were found between opinions and patients' comorbidities or dependency.
  
  
  CONCLUSIONS
  Differences within and across countries in nephrologists' opinions regarding starting and withdrawing haemodialysis reflect differences in access to haemodialysis and the practice of withdrawal of haemodialysis in their facilities.
authors.affiliation: Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Lambie
authors.forename: Hugh C
authors.initials: HC
authors.lastname: Rayner
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Bragg-Gresham
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Pisoni
authors.forename: Vittorio E
authors.initials: VE
authors.lastname: Andreucci
authors.forename: Bernard
authors.initials: B
authors.lastname: Canaud
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
authors.forename: Eric W
authors.initials: EW
authors.lastname: Young
mesh_terms: D005060:Europe / Q000453:epidemiology; D005602:France / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D007674:Kidney Diseases / Q000453:epidemiology / Q000628:therapy; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D028761:Withholding Treatment / Q000706:statistics & numerical data*