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New Renal Failure Patients Prefer Peritoneal Dialysis over Hemodialysis

It might be time to offer more information about dialysis options to new ESRD patients.

New end-stage renal disease (ESRD) patients must choose between hemodialysis (HD) and peritoneal dialysis (PD), but conflicting results about survival rates and outcomes have been reported for these options. In a U.S. prospective cohort study, which was conducted in 37 dialysis centers that offered both PD and HD, researchers assessed dialysis satisfaction among 736 new ESRD patients.

Satisfaction and health status were assessed with standardized questionnaires at a mean of 7 weeks after dialysis was begun. Compared with HD patients, PD patients were about 1.5 times to 2 times more likely to rate items pertaining to care and satisfaction as "excellent." Overall, 85% of PD patients and 56% of HD patients rated their care as excellent. Adjustment for a wide range of demographic factors did not alter the results.

Comment: An editorialist notes that PD use has declined to only 7.5% of new dialysis patients in the U.S. in 2001, despite equal or better outcomes and lower costs for home-based PD. This rate is lower than rates in other developed countries. The editorialist speculates that better physician training in PD, earlier patient referral, and earlier dialysis planning might increase use of PD. Meanwhile, the results of this study might help physicians offer better information about available choices to new ESRD patients.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine March 5, 2004

Citation(s):

Rubin HR et al. Patient ratings of dialysis care with peritoneal dialysis vs hemodialysis. JAMA 2004 Feb 11; 291:697-703.

• Original article (Subscription may be required)
• Medline abstract (Free)

Heaf J. Underutilization of peritoneal dialysis. JAMA 2004 Feb 11; 291:740-2.

• Original article (Subscription may be required)
• Medline abstract (Free)