title: Hemodialysis patient preference for type of vascular access: variation and predictors across countries in the DOPPS.
abstract: OBJECTIVE
  Catheters are associated with worse clinical outcomes than fistulas and grafts in hemodialysis (HD) patients. One potential modifier of patient vascular access (VA) use is patient preference for a particular VA type. The purpose of this study is to identify predictors of patient VA preference that could be used to improve patient care.
  
  
  METHODS
  This study uses a cross-sectional sample of data from the Dialysis Outcomes and Practice Patterns Study (DOPPS 3, 2005-09), that includes 3815 HD patients from 224 facilities in 12 countries. Using multivariable models we measured associations between patient demographic and clinical characteristics, previous catheter use and patient preference for a catheter.
  
  
  RESULTS
  Patient preference for a catheter varied across countries, ranging from 1% of HD patients in Japan and 18% in the United States, to 42% to 44% in Belgium and Canada. Preference for a catheter was positively associated with age (adjusted odds ratio per 10 years=1.14; 95% CI=1.02-1.26), female sex (OR 1.49; 95% CI=1.15-1.93), and former (OR=2.61; 95% CI=1.66-4.12) or current catheter use (OR=60.3; 95% CI=36.5-99.8); catheter preference was inversely associated with time on dialysis (OR per three years=0.90; 95% CI=0.82-0.97).
  
  
  CONCLUSIONS
  Considerable variation in patient VA preference was observed across countries, suggesting that patient VA preference may be influenced by sociocultural factors and thus could be modifiable. Catheter preference was greatest among current and former catheter users, suggesting that one way to influence patient VA preference may be to avoid catheter use whenever possible.
authors.affiliation: Division of Nephrology and Hypertension, Vanderbilt University School of Medicine, Nashville, Tennessee - USA.
authors.forename: Rachel B
authors.initials: RB
authors.lastname: Fissell
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Fuller
authors.forename: Hal
authors.initials: H
authors.lastname: Morgenstern
authors.forename: Brenda W
authors.initials: BW
authors.lastname: Gillespie
authors.forename: David C
authors.initials: DC
authors.lastname: Mendelssohn
authors.forename: Hugh C
authors.initials: HC
authors.lastname: Rayner
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Robinson
authors.forename: Dori
authors.initials: D
authors.lastname: Schatell
authors.forename: Hideki
authors.initials: H
authors.lastname: Kawanishi
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Pisoni
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D062905:Central Venous Catheters / Q000009:adverse effects; D003430:Cross-Sectional Studies; D003466:Cultural Characteristics; D005060:Europe / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009520:New Zealand / Q000453:epidemiology; D016017:Odds Ratio; D057240:Patient Preference / Q000208:ethnology; D010818:Practice Patterns, Physicians'; D006435:Renal Dialysis; D012737:Sex Factors; D014481:United States / Q000453:epidemiology