The role of personal attitudes of control and responsibility for the uptake of peritoneal dialysis- a national survey among dialysis patients

Abstract

Background Although most patients are suitable for both hemodialysis (HD) and peritoneal dialysis (PD), there seem to be differences in the outlook of patients who choose one modality over the other. There is currently limited literature about the impact of patients’ personal attitudes on the decision for PD or HD. In this study, we tried to find out whether there were differences between patients who were on HD and PD in their desire for control and responsibility for their treatment. Methods The data were drawn from a nationwide postal survey of 630 HD and PD patients. Patients’ desire for control was measured by scores on the internal locus of control (ILOC) scale. Patients were also asked how important taking responsibility for their dialysis had been for their treatment decision (ITR). Two multivariate logistic regression models, both adjusted for age, were applied to investigate whether there were differences between HD and PD patients in ILOC and ITR. Having one generic measure (ILOC) and one tailored to the dialysis context (ITR) gave the opportunity to investigate if it is a generic personality trait or rather a specific attitude that affects choice of dialysis modality. Results PD patients were younger and showed higher ILOC and ITR values. Multivariate logistic regression models adjusted for age confirmed the significant influence of ILOC and ITR on the uptake of PD. The odds ratios for being in the PD group were 1.53 for ILOC (p = 0.030; 95% CI 1.04–2.25), 1.49 for ITR (p = 0.019; 95% CI 1.07–2.07), and 0.95 (p = 0.000; 95% CI 0.94–0.97) for age in both models. Conclusions Our analysis shows the impact of personal attitudes on the uptake of PD. Participants who generally want to keep control of their lives and take responsibility for their dialysis treatment tended to choose PD. As PD is a home dialysis treatment that requires patients to participate and contribute, it is beneficial if patients’ personalities support the treatment procedure. Having two completely different treatment options that suit to different personalities gives us the opportunity to consider the relationship between personal attitudes and choice of dialysis modality. Trial registration The MAU-PD study is registered at the German Clinical Trials Register. DRKS-ID: DRKS00012555. Date of Registration in DRKS: 2018/01/04.

Prevalence, clinical course and outcomes of COVID-19 in peritoneal dialysis (PD) patients: a single-center experience

“…The question that arises is why PD patients have such a low rate of vaccine hesitancy than HD counterparts? Likely a better understanding of own health status and a high level of accountability in PD patients may explain a higher rate of COVID-19 vaccine acceptance in this population [ 20 ]. Another hypothesis may be the exclusion of vulnerable and marginalized patients from PD treatment.…”

Kidney Supportive Care in Peritoneal Dialysis: Developing a Person-Centered Kidney Disease Care Plan

“…Lastly, patients undergoing PD are perhaps more likely-implicit to their eligibility and subsequent selection of this home-based modality-to have better functional status, prioritize autonomy and self-directed care, a higher degree of psychosocial support, or both. [13] As a result, the need for kidney supportive care in PD patients may be even greater than that of those on HD due to 1) potentially greater decision-making complexity and wider range of treatment options to consider; 2) greater magnitude of prognostic uncertainty with fewer available prognostic tools, 3) possible differences in range or type of symptoms experienced; and 4) subsequent importance of understanding individual PD patient motivations. These issues necessitate attention to upstream, longitudinal goal-directed conversations that adapt with PD patients' values and priorities over time.…”

“…In a large survey in Germany of over 600 maintenance patients, investigators showed that patient attitudes regarding dialysis may differ between patients electing PD versus HD; PD patients prioritized autonomy and/or taking control of their own care in dialysis modality selection. [59] Coping strategies most often utilized by PD patients in the Empowering Patients on Choices for Renal Replacement Therapy (EPOCH-RRT) cohort were cognitive restructuring and problem solving; although social support was also identified as a coping strategy for some, it was not as frequently employed as by HD patients. [60] These results provide insight into some of the most prominent patient-described perspectives and motivations of PD patients.…”

“…Last, patients undergoing PD are perhaps more likely—implicit to their eligibility and subsequent selection of this home-based modality—to have better functional status prioritizing autonomy and self-directed care, a higher degree of psychosocial support, or both. 13 …”

Automated Peritoneal Dialysis: Patient Perspectives and Outcomes

“…Individuals choosing PD show high desire for control and are confident in taking responsibility for their therapy. 42 Patient/caregiver perceived advantages and drawbacks of APD are summarized in Table 2.…”