“Why I Chose Hemodialysis over Peritoneal Dialysis”: An Opinion Survey among In-Center Hemodialysis Patients

Abstract

Peritoneal dialysis (PD) penetration in India remains low despite the huge chronic kidney disease burden and unmet need for renal replacement therapy (RRT). In order to understand the socioeconomic reasons that govern patients' preference for hemodialysis (HD), we carried out an opinion survey among prevalent in-center HD patients at our institution using a multiple response questionnaire that was verbally administered to them at the dialysis facility by the investigators. Close to 80% were self-financed and 49.5% were on twice weekly HD. Despite the majority (95%) receiving RRT education from a nephrologist, 43.4% were not aware of PD as an RRT modality. The treating nephrologist's recommendation was the most important reason given for choosing HD (77.8%) and not choosing PD (69.7%). Other reasons for not choosing PD included lack of a dedicated caregiver or "clean area" at home (15.1%), fear of infection (15.1%), disruption of work (14.1%), and the high cost of PD (7%). The perceived advantages of HD over PD were greater convenience because of need for only twice or thrice weekly sessions (61%), supervised care received in a hospital setting (28.8%), and less disruption of the patient's and family's routine (22%). We discuss the implications of these findings and what policy makers and nephrologists in India and other developing countries can do to improve PD penetration and utilization.

The Potential Burden of Home Dialysis on Patients and Caregivers: A Narrative Review

“…16-18 Conversely, in PD, patients may have concerns dealing with PD catheter dysfunction, adequacy of technique, cycler alarms or malfunction, and fear of the development of peritonitis. 19 As such, some patients may experience ongoing concerns regarding the risks of adverse events and of inadequately performing dialysis on their own. This may potentially lead to psychosocial distress, poor compliance, and even therapy discontinuation, which may all negatively impact clinical outcomes and quality of life.…”

Comparison of patient survival and technique survival between continuous ambulatory peritoneal dialysis and automated peritoneal dialysis

“…2 The major reasons why patients do not choose PD include a higher technique failure rate for PD compared to HD, fear of infectious complications, inconvenience, and technique difficulty. 3,4…”

“…2 The major reasons why patients do not choose PD include a higher technique failure rate for PD compared to HD, fear of infectious complications, inconvenience, and technique difficulty. 3,4 Continuous ambulatory PD (CAPD) is performed manually, while automated PD (APD) is performed with the help of a cycler. Costs of both modalities can be claimed for reimbursement from the government-administered health insurance in Taiwan.…”

A simple novel device can provide independence for peritoneal dialysis patients

“…Technical innovations in PD in the 1980s, including development of disconnect system Y-set, flush before fill and the double bag system significantly reduced the rate of peritonitis. 1,2 There were also multiple technology attempts to improve the PD connection technique, like Stay-safe® technology (Fresenius), UV-FLASH TM germicidal exchange device (Baxter), PeritoneX that developed by the Relavo team in attempt to reduce infection risk. 3 Another technical innovation – the automatic PD machine – is a landmark in PD therapy that allows patients more independence and flexibility in performing PD within their daily routine.…”