Differences between dialysis modality selection and initiation.
BACKGROUND
Although dialysis modality education is associated with higher rates of peritoneal dialysis (PD) use, some patients start hemodialysis (HD) therapy despite initially selecting PD as their modality of choice. This study seeks to identify predictors of this discrepancy.


METHODS
Retrospective cohort study.


METHODS
217 patients who received dialysis modality education at the University of Rochester between January 2004 and September 2009 and subsequently started dialysis therapy.


METHODS
Demographic (age, race, sex, and timing of education), social (education, income, insurance, marital, employment, and smoking status), and clinical data (estimated glomerular filtration rate, cause of end-stage renal disease [ESRD], number of comorbid conditions, and number of nephrology visits).


RESULTS
HD use at initiation and day 91 of dialysis therapy in patients initially selecting PD.


RESULTS
Of 217 patients receiving education and starting dialysis therapy, at the time of education, 124 chose PD, 52 were undecided, and 41 chose HD. Modality distribution at the time of dialysis therapy initiation was 150 with HD and 67 with PD. Of 124 patients who chose PD at the time of education, 59 started dialysis therapy with PD and 65 started with HD. On day 91, a total of 60 patients were on PD therapy and 55 were on HD therapy. Nine patients had either died, undergone transplant, or not yet reached 91 days of dialysis therapy. On multivariable analysis, nonglomerular cause of ESRD, age older than 75 years, and not being employed predicted starting with HD therapy, whereas age older than 75 years, nonwhite race, and nonglomerular cause of ESRD predicted HD use at day 91.


CONCLUSIONS
Single-center observational study.


CONCLUSIONS
This study shows that patients choosing PD after dialysis education may not start with this modality and identifies several predictors of this mismatch. Further investigation into predictors of this discrepancy and strategies promoting a PD start in patients selecting this modality are warranted.
Department of Medicine, Division of Nephrology, University of Rochester, Rochester, NY, USA. scott_liebman@urmc.rochester.edu
Scott E
SE
Liebman
David A
DA
Bushinsky
James G
JG
Dolan
Peter
P
Veazie
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior; D015331:Cohort Studies; D004651:Employment; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010530:Peritoneal Dialysis; D006435:Renal Dialysis; D012189:Retrospective Studies