Exploring Preconceptions as Barriers to Peritoneal Dialysis Eligibility: A Global Scenario-Based Survey of Kidney Care Physicians

Abstract

IntroductionDespite growing number of patients requiring kidney replacement therapy peritoneal dialysis (PD) is underutilized globally. A contributory factor may be clinician myths around its use. The aim of this study was to explore perceptions around PD initiation by clinicians according to various physical, social and clinical characteristics of patients. MethodsAn online global survey (English, Thai) was administered to ascertain nephrologists’ and nephrology trainees’ decisions on recommending PD as a treatment modality. Results645 participants (522 nephrologists; 123 trainees; 56% male) from 54 countries (66% high income countries (HICs), 22% upper middle income, 12% low middle income countries and 1% from lower income countries) completed the survey. 81% of respondents identified as attending physicians/consultants with 19% trainees or other. PD was recommended for most scenarios including repeated exposures to heavy lifting, swimming (especially in a private pool and ocean), among patients with cirrhosis or cognitive impairment with available support, and those living with a pet if a physical separation can be achieved during PD. Certain abdominal surgeries were more acceptable to proceed with peritoneal dialysis (hysterectomy 90%) compared to others (hemicolectomy 45%). Similar variation was noted for different types of stomas (nephrostomies 74%; suprapubic catheters 53%; ileostomies 27%). ConclusionsThe probability of recommending PD in various scenarios was greater among clinicians from HICs, larger units and consultants with more clinical experience. There is a disparity in recommending PD across various clinical scenarios driven by experience, unit-level characteristics and region of practice. Globally, evidence-informed education is warranted to rectify misconceptions to enable greater PD uptake.