Factors influencing patient choice of dialysis versus conservative care to treat end-stage kidney disease.
BACKGROUND
For every patient with chronic kidney disease who undergoes renal-replacement therapy, there is one patient who undergoes conservative management of their disease. We aimed to determine the most important characteristics of dialysis and the trade-offs patients were willing to make in choosing dialysis instead of conservative care.


METHODS
We conducted a discrete choice experiment involving adults with stage 3-5 chronic kidney disease from eight renal clinics in Australia. We assessed the influence of treatment characteristics (life expectancy, number of visits to the hospital per week, ability to travel, time spent undergoing dialysis [i.e., time spent attached to a dialysis machine per treatment, measured in hours], time of day at which treatment occurred, availability of subsidized transport and flexibility of the treatment schedule) on patients' preferences for dialysis versus conservative care.


RESULTS
Of 151 patients invited to participate, 105 completed our survey. Patients were more likely to choose dialysis than conservative care if dialysis involved an increased average life expectancy (odds ratio [OR] 1.84, 95% confidence interval [CI] 1.57-2.15), if they were able to dialyse during the day or evening rather than during the day only (OR 8.95, 95% CI 4.46-17.97), and if subsidized transport was available (OR 1.55, 95% CI 1.24-1.95). Patients were less likely to choose dialysis over conservative care if an increase in the number of visits to hospital was required (OR 0.70, 95% CI 0.56-0.88) and if there were more restrictions on their ability to travel (OR=0.47, 95%CI 0.36-0.61). Patients were willing to forgo 7 months of life expectancy to reduce the number of required visits to hospital and 15 months of life expectancy to increase their ability to travel.


CONCLUSIONS
Patients approaching end-stage kidney disease are willing to trade considerable life expectancy to reduce the burden and restrictions imposed by dialysis.
Sydney School of Public Health, the University of Sydney, Sydney, Australia. rachael.morton@sydney.edu.au
Rachael L
RL
Morton
Paul
P
Snelling
Angela C
AC
Webster
John
J
Rose
Rosemary
R
Masterson
David W
DW
Johnson
Kirsten
K
Howard
D000367:Age Factors; D000368:Aged; D001071:Appointments and Schedules; D001294:Attitude to Health; D001315:Australia; D002755:Choice Behavior; D015897:Comorbidity; D017281:Cost of Illness; D003657:Decision Making; D005260:Female; D006761:Hospitals; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D011788:Quality of Life; D006435:Renal Dialysis; D014187:Transportation of Patients; D014195:Travel