title: Factors influencing the decision to start renal replacement therapy: results of a survey among European nephrologists.
abstract: BACKGROUND
  Little is known about the criteria nephrologists use in the decision of when to start renal replacement therapy (RRT) in early referred adult patients. We evaluated opinions of European nephrologists on the decision for when to start RRT.
  
  
  METHODS
  European web-based survey.
  
  
  METHODS
  Patient presentations described as uncomplicated patients, patients with unfavorable clinical and unfavorable social conditions, or patients with specific clinical, social, and logistical factors.
  
  
  METHODS
  Nephrologists from 11 European countries.
  
  
  METHODS
  We studied opinions of European nephrologists about the influence of clinical, social, and logistical factors on decision making regarding when to start RRT, reflecting practices in place in 2009. Questions included target levels of kidney function at the start of RRT and factors accelerating or postponing RRT initiation. Using linear regression, we studied determinants of target estimated glomerular filtration rate (eGFR) at the start of RRT.
  
  
  RESULTS
  We received 433 completed surveys. The median target eGFR selected to start RRT in uncomplicated patients was 10.0 (25th-75th percentile, 8.0-10.0) mL/min/1.73 m(2). Level of excretory kidney function was considered the most important factor in decision making regarding uncomplicated patients (selected by 54% of respondents); in patients with unfavorable clinical versus social conditions, this factor was selected by 24% versus 32%, respectively. Acute clinical factors such as life-threatening hyperkalemia refractory to medical therapy (100%) and uremic pericarditis (98%) elicited a preference for an immediate start, whereas patient preference (69%) and vascular dementia (66%) postponed the start. Higher target eGFRs were reported by respondents from high- versus low-RRT-incidence countries (10.4 [95% CI, 9.9-10.9] vs 9.1 mL/min/1.73 m(2)) and from for-profit versus not-for-profit centers (10.1 [95% CI, 9.5-10.7] vs 9.5 mL/min/1.73 m(2)).
  
  
  CONCLUSIONS
  We were unable to calculate the exact response rate and examined opinions rather than practice for 433 nephrologists.
  
  
  CONCLUSIONS
  Only for uncomplicated patients did half the nephrologists consider excretory kidney function as the most important factor. Future studies should assess the weight of each factor affecting decision making.
authors.affiliation: European Renal Association-European Dialysis and Transplant Association Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. m.w.vandeluijtgaarden@amc.nl
authors.forename: Moniek W M
authors.initials: MW
authors.lastname: van de Luijtgaarden
authors.forename: Marlies
authors.initials: M
authors.lastname: Noordzij
authors.forename: Charles
authors.initials: C
authors.lastname: Tomson
authors.forename: Cécile
authors.initials: C
authors.lastname: Couchoud
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cancarini
authors.forename: David
authors.initials: D
authors.lastname: Ansell
authors.forename: Willem-Jan W
authors.initials: WJ
authors.lastname: Bos
authors.forename: Friedo W
authors.initials: FW
authors.lastname: Dekker
authors.forename: Jose L
authors.initials: JL
authors.lastname: Gorriz
authors.forename: Christos
authors.initials: C
authors.lastname: Iatrou
authors.forename: Liliana
authors.initials: L
authors.lastname: Garneata
authors.forename: Christoph
authors.initials: C
authors.lastname: Wanner
authors.forename: Svjetlana
authors.initials: S
authors.lastname: Cala
authors.forename: Olivera
authors.initials: O
authors.lastname: Stojceva-Taneva
authors.forename: Patrik
authors.initials: P
authors.lastname: Finne
authors.forename: Vianda S
authors.initials: VS
authors.lastname: Stel
authors.forename: Wim
authors.initials: W
authors.lastname: van Biesen
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
mesh_terms: D000328:Adult; D000368:Aged; D003625:Data Collection / Q000379:methods / Q000639:trends*; D003657:Decision Making; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D007677:Kidney Function Tests / Q000379:methods / Q000639:trends; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000379:methods / Q000639:trends*; D010820:Physicians / Q000639:trends*; D017582:Renal Replacement Therapy / Q000379:methods / Q000639:trends*