Choice Of Dialysis Research Articles

Young adults with kidney failure lived experiences of kidney replacement therapy decision-making.

Young adults living with kidney failure make decisions to select a kidney replacement therapy choice in partnership with healthcare professionals. However, little is known about how they experience kidney replacement therapy treatment decision-making and the impact this has on their well-being. To explore young adults living with kidney failure experiences of treatment decision-making. The treatment decision-making investigated is about the choice of dialysis and/or kidney transplant options. A qualitative interpretive hermeneutic phenomenology study. Purposeful sampling was used to recruit young adults with kidney failure from social media, electronic media such as local kidney group websites and word of mouth. Semistructured interviews were conducted with (n = 18) participants aged 18-30 years. Inductive analysis of the data were performed using Braun and Clarke's thematic analysis framework. The five themes generated were (1) awareness and anticipation of future kidney replacement therapy decision; (2) health information and education; (3) engaging in decision-making, support and choices; (4) implementation of kidney replacement therapy and transitioning into the new normal life and (5) the impact of decision-making and choice on well-being. Decision-making significantly affected young adults' psychosocial and mental well-being. Young adults had unmet informational and decisional needs and struggled to cope due to lack of support. A four-talk model, with an implement talk phase added to the existing three-talk (team talk, option talk, decision talk) shared decision-making model, would promote a focus on the implementation of choice and support the transitioning from previous life to long-term dependence on treatment.

Nephrologists’ Perspectives on Home Dialysis Utilization: A National Survey From Israel

Nephrologists’ Perspectives on Home Dialysis Utilization: A National Survey From Israel

Patient perspectives on chronic kidney disease and decision-making about treatment. Discourse of participants in the French CKD-REIN cohort study

BackgroundLittle is known about psychological issues in patients with chronic kidney disease (CKD) facing transition to kidney failure and the involvement of their family in decision-making about kidney replacement therapy (KRT). This study investigated patients’ experience of their illness, their views on KRT choice and their perception of the influence of their relatives.MethodsWe conducted a qualitative study nested in the CKD-REIN prospective cohort study which included non-dialysis CKD patients from 40 nationally representative nephrology clinics. Among 1555 patients who returned a self-administered questionnaire, we used purposive sampling to select 50 participants who underwent semi-structured phone interviews with a psychologist.ResultsThe patients' mean age was 62.2 ± 12 years, 42% were women, and 68% had CKD stage 4–5. The analysis yielded four lexical classes: “illness rhythm”, “considering dialysis”, “family and transplantation”, and “disease, treatment choice and introspection”. When experiencing few or mild symptoms, patients tended to avoid thinking about CKD, for the prospect of dialysis was the most stressful part of their experience. Surprisingly, the importance of family appeared when they talked about transplantation decision-making, but not about choice of dialysis modality.ConclusionsCognitive avoidance seems common in patients with advanced CKD. Transplantation and dialysis decision-making appear to be two distinct processes, with different levels of family involvement. More research is needed to better understand the frequency and impact of cognitive avoidance on patients’ well-being and decision-making.Graphic abstract

MO706PATIENTS AND CENTER-RELATED FACTORS IN PERIOTONEAL CHOICE IN INCIDENT PATIENTS: A REGIONAL EXPERIENCE

Abstract Background and Aims Effective outpatient organization is essential in the management of patients with chronic kidney disease. Although peritoneal dialysis (PD) has many advantages it is still not popular. Method The aim of this study was to evaluate patient and center-related factors that affect the final choice of peritoneal dialysis (PD) versus hemodialysis (HD) in the Calabrian region (Italy). We analyzed 2 annual regional surveys performed by nephrologists (2017 and 2018) in incident dialysis patients. Collected factors included: early and late referral to the dialysis program, pre-dialysis participation in outpatient visits, first dialysis access [peritoneal catheter (PC), central venous catheter (CVC), arteriovenous fistula (AVF)], final dialysis treatment (HD or PD) and the care giver. Results The study sample included 296 incident patients (63% males) aged 66±15 years. Time to referral influenced the type of first dialysis access. Among patients with early referral, 35% initiated dialysis by a PC, 34% by AVF and 31% by CVC, while among those with late referral, only 5% started dialysis by a PC, 15% by AVF, and the majority (80%) by CVC (P<0.001). Time to referral was also associated with pre-dialysis visits (34%, 33% and 34% versus 5%, 22% and 73%, respectively, P<0.001). When evaluating clinical suitability for treatment modality, 54% of early referrals and 45% of late referrals were eligible for PD. The choice of dialytic modality was again related to time to referral: 38% with early referral chose PD compared to 15% of those with late referral (P<0.001). Furthermore, in patients who participated in the pre-dialysis program, 38% started PD versus 11% of patients that did not participate (P<0.001). The role of the caregiver remains uncertain. Conclusion These data confirm that a more attentive and dedicated organization of the pre-dialysis outpatient program would contribute to a greater expansion of the peritoneal dialysis program.

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

BackgroundAlthough 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.MethodsThe 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.ResultsPD 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.ConclusionsOur 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 registrationThe MAU-PD study is registered at the German Clinical Trials Register.DRKS-ID: DRKS00012555.Date of Registration in DRKS: 2018/01/04.

Choice of dialysis modality among patients initiating dialysis: results of the Peridialysis study.

BackgroundIn patients with end-stage kidney disease (ESKD), home dialysis offers socio-economic and health benefits compared with in-centre dialysis but is generally underutilized. We hypothesized that the pre-dialysis course and institutional factors affect the choice of dialysis modality after dialysis initiation (DI).MethodsThe Peridialysis study is a multinational, multicentre prospective observational study assessing the causes and timing of DI and consequences of suboptimal DI. Clinical and biochemical data, details of the pre-dialytic course, reasons for DI and causes of the choice of dialysis modality were registered.ResultsAmong 1587 included patients, 516 (32.5%) were judged unsuitable for home dialysis due to contraindications [384 ( 24.2%)] or no assessment [106 (6.7%); mainly due to late referral and/or suboptimal DI] or death [26 (1.6%)]. Older age, comorbidity, late referral, suboptimal DI, acute illness and rapid loss of renal function associated with unsuitability. Of the remaining 1071 patients, 700 (65.4%) chose peritoneal dialysis (61.7%) or home haemodialysis (HD; 3.6%), while 371 (34.6%) chose in-centre HD. Somatic differences between patients choosing home dialysis and in-centre dialysis were minor; factors linked to the choice of in-centre dialysis were late referral, suboptimal DI, acute illness and absence of a ‘home dialysis first’ institutional policy.ConclusionsGiven a personal choice with shared decision making, 65.4% of ESKD patients choose home dialysis. Our data indicate that the incidence of home dialysis potentially could be further increased to reduce the incidence of late referral and unplanned DI and, in acutely ill patients, by implementing an educational programme after improvement of their clinical condition.

Effects of dialysis modality choice on the survival of end-stage renal disease patients in southern China: a retrospective cohort study

BackgroundThe optimal choice of treatment, with hemodialysis (HD) or peritoneal dialysis (PD), for end-stage renal disease (ESRD) patients, is still controversial. Only a few studies comparing HD and PD have been conducted in China, which has the largest number of dialysis patients in the world.MethodsA retrospective cohort study was conducted on ESRD patients who began renal replacement treatment from January 1, 2012 to December 31, 2017 in Guangdong Provincial Hospital of Chinese Medicine. Propensity scoring match was applied to balance the baseline conditions and multivariate Cox regression analysis to compare the mortality between HD and PD patients, and evaluated the correlation between mortality and various baseline characteristics.ResultsA total of 436 HD patients and 501 PD patients were included in this study, and PD patients had better survival than HD patients, but the difference was not statistically significant. For younger ESRD patients (≤60-year-old), the overall survival of PD was better than that of HD, but HD was associated with a lower risk of death in older patients (> 70-year-old). This difference was still significant after adjustment for a variety of confounding factors. Female gender, age at dialysis initiation, cardiovascular disease, cholesterol, and HD were risk factors of all-cause mortality in the younger subgroup, while PD was risk factor in the older subgroup.ConclusionPD may be a better choice for younger ESRD patients, and HD for the older patients.

P1137FACTORS DETERMINING CHOICE OF DIALYSISI MODALITY AMONG PATIENTS INITIATING DIALYSIS. RESULTS OF THE PERIDIALYSIS STUDY

Abstract Background and Aims Home dialysis with peritoneal dialysis (PD) or home hemodialysis (HD) has medical and socioeconomic benefits but home dialysis is generally underutilized. While many factors determine choice of initial dialysis modality, starting patients on home dialysis requires timely planning, educational activities and an active program to promote home dialysis. Here we investigated factors including patient suitability, pre-dialysis preparations and institutional factors determining choice of dialysis modality among patients initiating dialysis. Method Choice of dialysis modality was investigated in 1588 consecutive patients (age 63.8 ±15.3 years. 35.8% female; diabetic nephropathy 24.4%) participating in the Peridialysis study, a multinational multi-centre prospective study of causes and timing of planned and unplanned dialysis initiation (DI) over a 3-year period in 15 Nordic and Baltic nephrology departments. All dialysis modalities were available and free of charge to patients. All centres offered pre-dialysis education programs to patients with timely referral. Clinical and biochemical data during the pre-dialytic period, centre data, and reasons for DI and choice of dialysis modality were registered. Results: 516 (32.4%) patients were not offered home dialysis because they were judged to be unsuitable (384; 24%): PD was contraindicated in 338 (21.2%) patients - for physical (142; 8.9%), mental (80, 5.0%) or abdominal (116; 7.3%) reasons and HD was contraindicated in 46 (2.9%) patients. In addition, 106 (6.7%) were not offered home dialysis for various reasons; and deaths before modality choice occurred in 26 (1.6%) patients. Factors associated with unsuitability were high age, comorbidity, late referral (risk ratio, RR, 1.9), inflammation (C-reactive protein >50 mg/L (RR 2.6) and rapid loss of renal function (RR 2.0). Patients who were not assessed for home dialysis comprised mainly patients with late referral (RR 5.8) and/or unplanned DI (RR 9.6). Of the remaining 1072 (67.6%) patients, who had a free choice of modality, 700 (65.3%) chose home dialysis, either PD (661; 61.7%) or home HD ( 39 3.6%) while 372 (34.7%) patients chose centre HD. Factors associated with choice of centre dialysis were late referral (RR 1.8), suboptimal DI (RR 2.0), symptomatic uraemia (RR 1.6) and p-urea >30 mM (2.6). Somatic differences between patients choosing home dialysis and centre dialysis were minor. Independent institutional factors reducing information about home dialysis were treatment at a university hospital (RR 4.3) and absence of an active preference for home dialysis, “home dialysis first” policy (RR 3.0). Conclusion The results of the Peridialysis study indicate that the incidence of home dialysis could be increased by a “home dialysis first” department policy and by efforts to reduce the incidence of late referrals and unplanned DI. Acutely ill patients and patients with unplanned DI may be candidates for home dialysis if assessment of home dialysis suitability and dialysis educational program are performed after their clinical condition has improved. Given a free choice, most patients (65%) choose home dialysis.

P1448FACTORS ASSOCIATED WITH INCREASED MORTALITY AFTER DIALYSIS INITIATION. RESULTS OF THE PERIDIALYSIS STUDY

Abstract Background and Aims Home dialysis with peritoneal dialysis (PD) or home hemodialysis (HD) has medical and socioeconomic benefits but home dialysis is generally underutilized. While many factors determine choice of initial dialysis modality, starting patients on home dialysis requires timely planning, educational activities and an active program to promote home dialysis. Here we investigated factors including patient suitability, pre-dialysis preparations and institutional factors determining choice of dialysis modality among patients initiating dialysis. Method Choice of dialysis modality was investigated in 1588 consecutive patients (age 63.8 ±15.3 years. 35.8% female; diabetic nephropathy 24.4%) participating in the Peridialysis study, a multinational multi-centre prospective study of causes and timing of planned and unplanned dialysis initiation (DI) over a 3-year period in 15 Nordic and Baltic nephrology departments. All dialysis modalities were available and free of charge to patients. All centres offered pre-dialysis education programs to patients with timely referral. Clinical and biochemical data during the pre-dialytic period, centre data, and reasons for DI and choice of dialysis modality were registered. Results: 516 (32.4%) patients were not offered home dialysis because they were judged to be unsuitable (384; 24%): PD was contraindicated in 338 (21.2%) patients - for physical (142; 8.9%), mental (80, 5.0%) or abdominal (116; 7.3%) reasons and HD was contraindicated in 46 (2.9%) patients. In addition, 106 (6.7%) were not offered home dialysis for various reasons; and deaths before modality choice occurred in 26 (1.6%) patients. Factors associated with unsuitability were high age, comorbidity, late referral (risk ratio, RR, 1.9), inflammation (C-reactive protein >50 mg/L (RR 2.6) and rapid loss of renal function (RR 2.0). Patients who were not assessed for home dialysis comprised mainly patients with late referral (RR 5.8) and/or unplanned DI (RR 9.6). Of the remaining 1072 (67.6%) patients, who had a free choice of modality, 700 (65.3%) chose home dialysis, either PD (661; 61.7%) or home HD ( 39 3.6%) while 372 (34.7%) patients chose centre HD. Factors associated with choice of centre dialysis were late referral (RR 1.8), suboptimal DI (RR 2.0), symptomatic uraemia (RR 1.6) and p-urea >30 mM (2.6). Somatic differences between patients choosing home dialysis and centre dialysis were minor. Independent institutional factors reducing information about home dialysis were treatment at a university hospital (RR 4.3) and absence of an active preference for home dialysis, “home dialysis first” policy (RR 3.0). Conclusion The results of the Peridialysis study indicate that the incidence of home dialysis could be increased by a “home dialysis first” department policy and by efforts to reduce the incidence of late referrals and unplanned DI. Acutely ill patients and patients with unplanned DI may be candidates for home dialysis if assessment of home dialysis suitability and dialysis educational program are performed after their clinical condition has improved. Given a free choice, most patients (65%) choose home dialysis.

Perspectives on decision making amongst older people with end-stage renal disease and caregivers in Singapore: A qualitative study.

BackgroundEnd‐stage renal disease (ESRD) is increasing both globally and in Asia. Singapore has the fifth highest incidence of ESRD worldwide, a trend that is predicted to rise. Older patients with ESRD are faced with a choice of haemodialysis, peritoneal dialysis or conservative management, all of which have their risks and benefits.ObjectiveThis study seeks to explore perspectives on decision making amongst older (≥70) Singaporean ESRD patients and their caregivers to undergo (or not to undergo) dialysis.DesignQualitative study design using semi‐structured interviews.Setting and participantsTwenty‐three participants were recruited from the largest tertiary hospital in Singapore: seven peritoneal dialysis patients, five haemodialysis patients, four patients on conservative management and seven caregivers.ResultsWhile some patients believed that they had made an independent treatment decision, others reported feeling like they had no choice in the matter or that they were strongly persuaded by their doctors and/or family members to undergo dialysis. Patients reported decision‐making factors including loss of autonomy in daily life, financial burden (on themselves or on their families), caregiving burden, alternative medicine, symptoms and disease progression. Caregivers also reported concerns about financial and caregiving burden.Discussion and conclusionThis study has identified several factors that should be considered in the design and implementation of decision aids to help older ESRD patients in Singapore make informed treatment decisions, including patients' and caregivers' decision‐making factors as well as the relational dynamics between patients, caregivers and doctors.

SUN-091 ARE YOU SURE? MEASURING DECISIONAL CONFLICT AROUND DIALYSIS TREATMENT CHOICE IN PATIENTS WITH END STAGE KIDNEY DISEASE

Patients with end stage kidney disease who have a planned dialysis start receive education about renal replacement therapies. However, they may still feel uncertain about their choice of dialysis when they start treatment. The SURE questionnaire is a 4 item checklist which screens for decisional conflict. SURE stands for: sure of myself; understand information; risk-benefit ratio; encouragement. (1). We used the SURE questionnaire to understand how frequent decisional conflict is when a patient starts dialysis (Table 1).

Association of incident dialysis modality with mortality: a protocol for systematic review and meta-analysis of randomized controlled trials and cohort studies

BackgroundAt least 2.6 million adults and children receive dialysis treatment for end-stage kidney disease (ESKD) worldwide. The large majority of these receive hemodialysis (HD), while the remaining receive peritoneal dialysis (PD). Peritoneal dialysis may be associated with similar mortality outcomes as HD, and patient-reported outcomes are potentially increased with PD. Existing evidence for the mortality associated with PD was summarized over 20 years ago, and there has been greater marginal improvement in survival with PD relative to HD since that time. It is therefore timely to reexamine the question of differential mortality by modality and summarize evidence from more contemporary practice settings.Methods/designElectronic databases will be systematically searched for publications that report the association between dialysis modality (HD or PD) with death from any cause and cause-specific death in incident patients with end-stage kidney disease. The database searches will be supplemented by searching through citations and references and consultation with experts. Studies published before 1995 will be excluded. Screening of both titles and abstracts will be done by two independent reviewers. All disagreements will be resolved by an independent third reviewer. A quantitative meta-analysis of effect sizes and standard errors will be applied.DiscussionOur systematic review will update previous evidence summaries and provide a quantitative and standardized assessment of the contemporary literature comparing HD and PD including published and unpublished non-English studies from greater China, Taiwan, and Japan. This review will inform shared decision-making around initial dialysis modality choice and jurisdiction-level considerations of dialysis practice.Systematic review registrationPROSPERO CRD42018111829

Qu’est-ce qui influence le choix de la dialyse péritonéale chez les patients ? une étude qualitative.

L’objectif de cette étude était d’identifier les facteurs qui influencent le choix de la dialyse péritonéale (DP) chez les patients insuffisants rénaux, dans un centre de dialyse en France offrant un dispositif d’éducation thérapeutique du patient (ETP) aux patients en pré-dialyse. Pour ce faire, nous avons mené trente six entretiens semi-directifs avec des patients, des médecins de l’équipe d’ETP et un cadre de santé. Nous avons également observé dix séances d’ETP afin d’explorer la nature des interactions entre les patients, leurs accompagnants et l’équipe soignante. Nos résultats révèlent que les facteurs qui poussent les patients à choisir la DP sont l’influence des proches, les préférences personnelles, l’influence des médecins, l’ETP à travers l’information transmise par les éducatrices. En plus de l’influence de ces facteurs dans la construction du choix des patients à s’orienter vers une méthode de dialyse, il pourrait être encore plus productif d’intégrer des patients ressources dans les dispositifs d’ETP grâce au partage de leur expérience de patients traités en dialyse avec les patients en pré-dialyse.
 
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La dialyse à domicile : une dynamique interactive complexe pour les couples

(English abstract at the end)
 La dialyse à domicile est reconnue comme étant la technique la moins coûteuse. Pourtant, elle est la moins choisie en France. Pourquoi la France se montre-t-elle frileuse quant au choix de cette technique ? Nous nous centrons, dans cet article, sur les aspects psychologiques de la prise en charge, par les conjoints, des patients hémodialysés à domicile. A ce sujet, les études sont contradictoires, certaines rapportent un mal-être des couples, tandis que d’autres mettent en évidence une meilleure qualité de vie pour les deux partenaires. Après avoir émis une critique concernant la méthodologie utilisée dans certains travaux qui évacuent la part subjective et certains éléments cliniques qualitatifs pourtant essentiels pour comprendre le phénomène, nous avons fait l’hypothèse que trois niveaux imbriqués méritent d’être pris en compte, jusqu’à être décisifs dans le choix de la dialyse : la dynamique psychologique de chacun des partenaires, la dynamique du couple et l’investissement psychologique du domicile. Nous concluons sur l’idée selon laquelle l’intégration du conjoint dans la prise en charge du malade peut être un atout pour les suites du traitement, sous réserve de certaines conditions : premièrement, une évaluation de la dynamique psychique du couple afin de limiter les échecs thérapeutiques et la souffrance psychologique ; deuxièmement, une sensibilisation des médecins et des soignants à ces questions, car le couple peut développer une relation d’autant plus pathologique que le traitement se fait à huit clos ; enfin, l’ouverture d’un espace de parole afin que les couples puissent exprimer leurs difficultés et être rassurés.
 Abstract
 Home dialysis is recognized as the least expensive technique. Yet it is the least chosen in France. Why is France being cautious about the choice of this technique? In this article, we focus on the psychological aspects of spousal management of home hemodialysis patients. In this regard, the studies are contradictory, some report a discomfort in couples, while others highlight a better quality of life for both partners. After criticizing the methodology used in some of the works that remove the subjective and some qualitative clinical elements that are essential to understanding the phenomenon, we hypothesized that three nested levels deserve to be taken into account, up to to be decisive in the choice of dialysis: the psychological dynamics of each partner, the dynamics of the couple and the psychological investment of the home. We conclude on the idea that the integration of the spouse in the care of the patient can be an asset for the continuation of treatment, subject to certain conditions: first, an assessment of the psychic dynamics of the couple to limit the therapeutic failures and psychological suffering; secondly, raising the awareness of doctors and caregivers about these issues, because the couple can develop a relationship which is all the more pathological as the treatment is done in camera; finally, the opening of a space of speech so that couples can express their difficulties and be reassured.
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Factors Associated with the Choice of Peritoneal Dialysis in Iran: Qualitative Study.

BACKGROUND:Decision making about the type of dialysis in renal failure is a matter of great importance involving the patients, his/her family, and the health care team. Identifying the factors influencing decision making for undergoing peritoneal dialysis (PD) helps the development of this therapeutic method in patients.AIM:The present study aims at explaining the factors influencing decision making about undergoing PD in End Stage Renal Failure patientsMETHOD:The present study is a qualitative research, which used content analysis method. A semi-structured and in-depth interview was conducted with the 19 participants that selected by purposefully sampling. All interviews were recorded subsequent to receiving consent of the participants and were analyzed using content analysis method.RESULTS:The first codification process resulted in 345 codes, which finally decreased to 278 codes by continuous reading and removal of duplicates. Overall, two main categories and eight categories namely facilitating factors (viz. family atmosphere, hemodialysis problems, PD advantages, and social environment) and inhibitory factors (viz. inefficient family, PD requirements, attitudes towards hemodialysis, and the country treatment system) were selected from the total 19 sub-categories and 278 codes.CONCLUSIONS:Results indicated that various personal, family-related, psychological, social, and economic factors could affect the decision on the type of dialysis in patients. Therefore, basic infrastructures such as social support, education, and even the specialist and positive perspective of the Ministry of Health are required to choose this therapeutic method.

Decision-making process in the pre-dialysis CKD patients: do anxiety, stress and depression matter?

BackgroundThe transition from pre-dialysis chronic kidney disease (CKD) to renal replacement therapy (RRT) is a stressful event. Anxiety, depression and stress are frequent conditions in this population, and might play a role on the choice of dialysis modality.MethodsThis is a prospective study that included stages 4-5 CKD patients during a dialysis multi-disciplinary education program. Demographic, clinical, and laboratory data were evaluated. Hospital Anxiety and Depression Scale and a Perceived Stress Scale assessed levels of anxiety, depression and stress, respectively.ResultsA total of 67 from 190 recruited patients were included (59 ± 15 years, 54% males). Comparing patients who chose peritoneal dialysis (PD) and hemodialysis (HD), there were no differences on anxiety (p = 0.55), and depression scores (p = 0.467), and stress (p = 0.854). Anxious (p = 0.007) and depressive (p = 0.030) patients presented lower levels of phosphate than those not affected. There was a significant correlation (p < 0.0001) between anxiety and depression scores (R2 = 0.573), anxiety and stress scores (R2 = 0.542), depression and stress scores (R2 = 0.514). At the end of study, 29.8% of patients had already started on dialysis, and scores of anxiety, depression and stress reduced significantly (all p values < 0.0001), from 5.9 ± 3.3 to 1.8 ± 1.8, from 7.7 ± 4.0 to 3.8 ± 2.9 and from 28.6 ± 7.8 to 10.0 ± 6.2, respectively, regardless of which therapy was chosen.ConclusionDepression, anxiety and perceived stress during final stages of CKD do not seem to be related to the choice of dialysis therapy and tend to decrease after dialysis initiation.

Developing and pilot testing a shared decision-making intervention for dialysis choice.

Evidence is inconclusive on how best to guide the patient in decision-making around haemodialysis and peritoneal dialysis choice. International guidelines recommend involvement of the patient in the decision to choose the dialysis modality most suitable for the individual patient. Nevertheless, studies have shown lack of involvement of the patient in decision-making. To develop and pilot test an intervention for shared decision-making targeting the choice of dialysis modality. This study reflects the first two phases of a complex intervention design: phase 1, the development process and phase 2, feasibility and piloting. Because decision aids were a part of the intervention, the International Patient Decision Aid Standards were considered. The pilot test included both the intervention and the feasibility of the validated shared decision-making questionnaire (SDM Q9) and the Decision Quality Measure (DQM) applied to evaluate the intervention. A total of 137 patients tested the intervention. After the intervention, 80% of the patients chose dialysis at home reflecting an increase of 23% in starting dialysis at home prior to the study. The SDM Q9 showed the majority of the patients experienced this intervention as shared decision-making. An intervention based on shared decision-making supported by decision aids seemed to increase the number of patients choosing home dialysis. The SDM Q9 and DQM were feasible evaluation tools. Further research is needed to gain insight into the patients' experiences of involvement and the implications for their choice of dialysis modality.

OPTIMIZATION OF PERITONEAL DIALYSIS ІN 7 STEPS OF EDUCATIONAL WORK WITH A PATIENT

Informing the end-stage renal disease (ESRD) patients about the modalities of dialysis renal replacement therapy (DRRT), patient’s aware choice of peritoneal dialysis (PD) and regular qualified medical training are the main components of successful implementation of PD program with obtaining optimal treatment results. The aim of the review is to summarize current knowledge regarding the process of modality selection and PD-patient training, improving professional development of the PD-specialists.

Facteurs influençant le choix de la dialyse péritonéale : le point de vue des patients et des néphrologues

PurposeTo identify factors related to the choice of peritoneal dialysis as a first dialysis technique: the viewpoint of patients and viewpoint of nephrologists. MethodsA retrospective multicenter study, type case-control was conducted in patients starting dialysis between 2010 and 2014 in 4 dialysis facilities in the PACA region. Nephrologists take care of patients included in the study were also interviewed. Data were collected using two standardized questionnaires: One for the patient and one for the nephrologists and using the French REIN registry. ResultsOne hundred and fifty patients were interviewed, the average age was 63.7 years. The medical contraindication for PD was present in 26.7%. Among patients eligible for both dialysis techniques, 46.7% had a preference for DP, 31.8% for HD and 21.5% did not have any preference. Patient preference is strongly influenced by information and the duration of predialysis nephrologist care (referral of nephrologist). The main factors related to personal choice of peritoneal dialysis are autonomy and desire for autonomy. Emergency dialysis influences negatively the choice of the PD. ConclusionA third of eligible patients for the 2 techniques could and wanted to be on PD. The limitations for PD are mainly related to professional practices. Better information could increase the utilization of PD to 32%.

혈액투석 환자의 우울과 삶의 질에서 질병인식의 통제효과

Purpose: This study aimed to evaluate the effect of illness perception on depression and quality of life in patients with hemodialysis. Methods: This is a cross-sectional study using structural equation modeling. Depression, quality of life and cognitive and emotional illness perceptions were measured by the Center for Epidemiologic Studies Depression-10 (CESD-10), Short Form-36 version 2 (SF-36v2), and Brief Illness Perception Questionnaire (BIPQ) in 272 hemodialysis patients. Results: Prevalence of depression was 76.1%, and higher in female patients on hemodialysis. Cognitive illness perception had effect on depression and quality of life, while emotional illness perception had effect only on depression. Quality of life was explained 69.6% through depression (β=-.74, t=-8.17) and cognitive illness perceptions (β=.21, t=3.06), while depression was explained 40.5% through cognitive (β=-.34, t=-5.99) and emotional(β=.59, t=9.37) illness perceptions. Conclusion: In the inevitable choice of dialysis, illness perception could decrease depression and improve quality of life in hemodialysis patients.