Nephrologist-Directed Primary Health Care in Chronic Dialysis Patients

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We previously found that chronic in-center hemodialysis patients relied on their nephrologists for the management of acute illnesses and comorbid chronic illnesses, such as diabetes mellitus and heart disease. Since chronic peritoneal dialysis differs from in-center hemodialysis, particularly in patients' exposure to nephrologists and other dialysis unit personnel, we asked chronic peritoneal dialysis patients about their reliance on nephrologists for general health care and compared their responses to those of in-center hemodialysis patients. A questionnaire consisting of patient demographic information and questions about primary medical care was completed by 118 chronic dialysis patients (74 in-center hemodialysis patients and 44 chronic peritoneal dialysis patients). Peritoneal dialysis patients were younger (mean age, 46 ± 17 years v 56 ± 17 years for hemodialysis patients, P <0.005) and fewer had been on dialysis for more than 3 years (32% v 65%, P <0.005). Seventy-one percent of all patients did not have a family physician (84 patients). More peritoneal dialysis patients had a family physician (43% v 20%, P <0.025), but the proportion of hemodialysis and peritoneal dialysis patients who had seen their family physician within 6 months was similar (73% and 47%, respectively, P = 0.12). Most patients relied on their nephrologist for yearly physicals (80% of hemodialysis and 84% of peritoneal dialysis patients). More hemodialysis patients depended on nephrologists for the management of minor acute illnesses (91 % v 64%, P <0.005). At least 60% of chronic health problems were managed by the nephrologists and was not different among the two patient groups. Surgical and medical subspecialty referrals also were similar in the patient groups; nearly half of all patients were referred to at least one subspecialist during the preceding year. No differences in nonnephrologist-directed health care and preventive care were seen among hemodialysis and peritoneal dialysis patients. Fifty-eight percent of patients had regular dental care and 55% had regular eye care. Sixty-eight percent of the women had a mammogram and 59% of the mammograms had been ordered by a nephrologist or nurse practitioner working in the hemodialysis unit. Since both hemodialysis and peritoneal dialysis patients depend on their nephrologists for most of their health care needs, dialysis unit protocols and renal fellowship training programs should emphasize the nephrologist's role as a primary health care provider for chronic dialysis patients.