Choice Of Dialysis Modality Research Articles

Differences in dialysis modality choice between immigrant and native populations in Barcelona, Spain.

Few studies have analyzed the freedom to choose their renal replacement treatment (RRT) modality in Spain. In a total of 673 patients with ACKD (stage 4 and 5) seen at the outpatient ACKD clinic of Hospital del Mar, Barcelona, Catalonia (Spain) from 2009 to 2020, we retrospectively compared immigrant and Spanish patients in order to analyze the impact of migration on RRT decision-making and its subsequent evolution in advanced CKD (ACKD) consultation and identifies the social and economic needs of this population. One hundred thirteen (16.8%) patients were immigrants and 560 were Spanish (83.2%). Migrants more frequently chose HD at a center (79.5%) than PD (12.5%) compared to Spaniards (HD 55.5% and 25% PD) despite being younger and more independent in basic and instrumental activities of daily living. Immigrant patients started RRT with lower eGFR (8.1 vs. 9.1 mL/min/1.73 m3) and after a shorter follow-up time in the ACKD consultation than the Spaniards (22 vs. 32 months). The language barrier was associated with a greater choice of center-based HD and active employment status favored the choice of PD. Spanish patients had a significantly higher relative risk of mortality compared with immigrant patients (HR = 3.27[95%CI:1.17-9.17], p = 0.024). However, after adjustment by age, this increased relative risk of mortality disappeared (HR 1.99[0.69-5.76], p = 0.206). Almost 60% individuals were not linked to social services. In conclusion, most immigrants in Barcelona choose center-HD versus DP despite being younger and more independent in basic and instrumental activities of daily living and being in a better condition than Spanish patients. Considering the socioeconomic and cultural needs of the immigrant population we serve is necessary to effectively reduce health inequities. Keywords: advanced chronic kidney disease, socioeconomic status, demographic factors, shared decision making, renal replacement therapy, peritoneal dialysis, conservative care, hemodialysis, renal transplantation, language barrier, social determinants of health, immigration, social determinants of health.

Population health strategies for health equity in chronic kidney disease management.

Chronic kidney disease (CKD) is a widespread health issue, affecting one out of every 10 adults. This prevalence is even higher among vulnerable and underserved populations, including low-income individuals, racial and ethnic minorities, and immigrants. Urban areas such as New York City and Los Angeles County offer municipal safety-net healthcare systems for these groups. Safety-net providers are essential to the healthcare landscape for vulnerable populations with chronic diseases including the Los Angeles County Health Services that exemplifies how effective population health strategies can be utilized to manage CKD and at-risk persons. These approaches focus on risk assessment, integrated practices, patient and care-partner education, cost reduction, and strategic partnerships. Kidney care tailored "Expected Practices" ensure that management strategies are equitable and based on clinical evidence. The eConsult system allows CKD patients' primary care providers to efficiently consult nephrologists, facilitating timely specialty care appointments through "Precision Scheduling." Priority goals include slowing CKD progression, equitable access to home dialysis, and preemptive kidney transplantation. As highlighted by Kalantar-Zadeh et al. in 2025 CJASN, advancing equitable kidney care through population health approaches support comprehensive and efficient CKD management, including diabetic kidney disease, in Los Angeles County's safety-net system. With a large, underserved patient population affected by CKD, urban safety-net healthcare systems like those in Los Angeles County emphasize early detection, multidisciplinary management, shared decision-making, and equitable access to CKD. They prioritize equitable access to home dialysis modality choice and kidney transplantation, aiming to improve outcomes and the quality-of-life for diverse patient groups.

Population health strategies for health equity in chronic kidney disease management: Retracted.

Chronic kidney disease (CKD) is a widespread health issue, affecting one out of every 10 adults. This prevalence is even higher among vulnerable and underserved populations, including low-income individuals, racial and ethnic minorities, and immigrants. Urban areas such as New York City and Los Angeles County offer municipal safety-net healthcare systems for these groups. Safety-net providers are essential to the healthcare landscape for vulnerable populations with chronic diseases including the Los Angeles County Health Services that exemplifies how effective population health strategies can be utilized to manage CKD and at-risk persons. These approaches focus on risk assessment, integrated practices, patient and care-partner education, cost reduction, and strategic partnerships. Kidney care tailored "Expected Practices" ensure that management strategies are equitable and based on clinical evidence. The eConsult system allows CKD patients' primary care providers to efficiently consult nephrologists, facilitating timely specialty care appointments through "Precision Scheduling." Priority goals include slowing CKD progression, equitable access to home dialysis, and preemptive kidney transplantation. As highlighted by Kalantar-Zadeh et al. in 2025 CJASN, advancing equitable kidney care through population health approaches support comprehensive and efficient CKD management, including diabetic kidney disease, in Los Angeles County's safety-net system. With a large, underserved patient population affected by CKD, urban safety-net healthcare systems like those in Los Angeles County emphasize early detection, multidisciplinary management, shared decision-making, and equitable access to CKD. They prioritize equitable access to home dialysis modality choice and kidney transplantation, aiming to improve outcomes and the quality-of-life for diverse patient groups.

Peritoneal Dialysis Modality Choice: Not an Automated Decision.

Peritoneal Dialysis Modality Choice: Not an Automated Decision.

Personalized decision-making for vascular access creation in hemodialysis.

Selecting the appropriate kidney replacement therapy (KRT) is crucial in order to secure optimal care for chronic kidney disease (CKD) patients with end-stage renal disease (ESRD). Next to renal transplantation, the choice of dialysis modality directly affects patient well-being, treatment effectiveness, and long-term outcomes.1 Therefore, clinical decision-making must take into account a range of factors to tailor decisions to each patient's unique needs. Previously, when the dialysis population was less diverse and resources more limited, straight-forward algorithms could be effectively implemented both for selection of KRT as well as for hemodialysis (HD) vascular access (VA). Recently, the growing ESRD population with more elderly being considered for dialysis care together with improved treatment opportunities have resulted in more challenging decision-making where on-size-fits-all strategies are being replaced by more tailored and personalized strategies aimed to ensure "the right dialysis access - to the right patient - at the right time - for the right reason." In this review, recent trends enforcing a more personalized approach in the selection of VA for HD are summarized and discussed, where these concerns have become especially relevant.

Combining telemedicine and in-person visits to deliver care to patients with severe chronic kidney disease (CKD): Lessons learned from COVID-19.

Telemedicine has been widely used to deliver healthcare to outpatients during the COVID-19 pandemic. The effectiveness of this modality is unclear in patients with a pre-dialysis stage of chronic kidney disease (CKD). This study aims to describe the clinical characteristics and management of CKD patients receiving telemedicine care during the COVID-19 pandemic. A retrospective single-center cohort study enrolled outpatients with pre-dialytic stage of CKD from March 9 to June 21, 2020. Telemedicine was proposed for all patients with a stable CKD to reduce the risk of in-hospital transmission whereas in-person visit was performed for patients requiring urgent evaluation. In a 15-week period, 97 patients received 116 nephrological visits. According to the modality of healthcare delivery, the patients were subdivided into telemedicine (66%) and in-person visit (34%) groups. Mean age of all CKD patients was 72.8 ± 12.5 years and males were 50.5% of the population. The average estimated glomerular filtration rate (eGFR) was 14.6±6 mL/min. Patients evaluated by telemedicine had better kidney function (GFR, 16.2±6.4 vs. 13.6±5.9 mL/min/1.73m2; p=0.037), a lower body mass index (BMI) (24.1 ± 1.7 vs. 30.6 ± 5.7; p=0.019), and a lower risk of CKD progression (51.1 vs. 25.4%, p=0.017) than patients requiring in-person visit. Telemedicine-visit patients experienced a significantly lower number of pharmacological changes than patients managed in the ambulatory setting. Telemedicine was also used to conduct 20% of educational meetings on the choice of dialysis modality and 18.9% of pre-eligibility visits for kidney transplantation. Telemedicine made it possible to provide care to and maintain close monitoring of 2/3 of patients with pre-dialytic stage of CKD during the COVID-19 pandemic.

#1722 Shared decision making and dialysis choice: an observational longitudinal cohort study

Abstract Background and Aims Shared decision-making is recommended for dialysis choice, whereby patients are supported in making decisions regarding dialysis modality together with healthcare professionals. The intervention ‘Shared decision making and dialysis choice’ has been a part of usual care at two hospitals in Denmark since 2018. The aim of this study was to describe the choice of dialysis modality and the outcomes for patients with kidney failure, who received a Shared decision-making intervention. Method An observational longitudinal cohort study was conducted. Data was collected retrospectively from 2018 to 2023 involving 484 patients with kidney failure from two Danish hospitals one regional hospital and one university hospital. Fisher's exact tests and Wilcoxon rank-sum tests were used to assess whether choice of dialysis modality differed significantly. Additionally, Aalen-Johansen estimation assessed time from the shared decision making intervention to treatment initiation, concordance between chosen and initiated treatment, and mortality before treatment initiation. Logistic regression and Cox proportional hazards evaluated the patient characteristics predicting these three outcomes. Results After the intervention, 68% chose home-based treatment, while 32% chose hospital-based treatment. With significant difference, more patients age ≤70 years, at university hospital and living with a partner chose home-based treatment. Half of the patients initiated treatment within 11 months, and predictors for initiating dialysis later than 11 months after the intervention were age ≥70 years (OR 2.52) and eGFR >15 ml/min/1.73 m² (2.80). 83% of the patients received the treatment chosen and predictors for concordance were center-based dialysis (HR 1.54), regional hospital (HR 1.52) and very mild to mild frailty (HR 1.55). Furthermore, 12% of the patients died before treatment initiation predicted by very mild (HR 3.67) to severe frailty (HR 6.42) and BMI <25 kg/m² (HR 2.84). Conclusion A high proportion of patient chose a home-based treatment after receiving the intervention ‘Shared decision making and dialysis choice’ and also initiated the dialysis choice chosen. Patients received the intervention timely and only few patients died before initiating dialysis. Our study has demonstrated that many factors influence patient choices and outcomes. Maybe routinely assessment of frailty and BMI prior to shared decision making intervention could improve the patient pathway.

What are the factors that determine treatment choices in patients with kidney failure: a retrospective cohort study using data linkage of routinely collected data in Wales

ObjectivesTo identify the factors that determine treatment choices following pre-dialysis education.DesignRetrospective cohort study using data linkage with univariate and multivariate analyses using linked data.SettingSecondary care National Health Service Wales healthcare...

Is health-related quality of life trajectory associated with dialysis modality choice in advanced chronic kidney disease?

Patients with advanced chronic kidney disease have lower health-related quality of life (HRQOL) than the general population. There is uncertainty regarding patterns of HRQOL changes before dialysis initiation. This study aimed to characterise HRQOL trajectory and assess its potential association with intended dialysis modality. This prospective single-centre cohort study followed adults with an estimated glomerular filtration rate ≤15 mL/min/1.73 m2 for one year. Patients were allocated into one of two groups based on their intended treatment modality, 'home dialysis' (peritoneal dialysis or home haemodialysis (HD)) and 'other' (in-centre HD or conservative care). Follow-up was for up to 1 year or earlier if initiated on kidney replacement therapy or died. Kidney Disease Quality of Life - Short Form (KDQOL-SF) was completed every 6 months. Predictors of changes in KDQOL-SF components were modelled using mixed effect multivariable linear regressions. One hundred and nine patients were included. At baseline, crude physical composite summary (PCS) (45 ± 10 vs. 39 ± 8) was higher in patients choosing home dialysis (n = 41), while mental composite summary (MCS) was similar in both groups. After adjustment, patients choosing home dialysis had an increase in MCS (B = 8.4 per year, p = 0.007) compared to those selecting in-centre HD/conservative care. This translates into an annual increase in MSC by 3 points for the 'home dialysis' group, compared to an annual decline by 5.4 points in the 'other' group. There was no difference in PCS trajectory through time. Patients choosing home dialysis had improved MCS over time compared to those not selecting home dialysis. More work is needed to determine how differences in processes of care and/or unmeasured patient characteristics modulate this association.

The use of continuous renal replacement therapy in critically ill patients with COVID-19-related acute kidney injury

Background/Aim. Patients with severe clinical COVID-19 are at higher risk of developing acute kidney injury (AKI). The aim of the study was to analyze the risk factors for AKI/AKI on chronic kidney disease (CKD) and the results of treatment using continuous renal replacement therapy (CRRT) in critically ill COVID-19 patients. Methods. The study included 101 COVID-19 patients with AKI treated with CRRT out of a total of 293 patients with AKI. The study was conducted from March 2020 to July 2021 at the University Clinical Center of Vojvodina, Serbia. Results. The average age of patients was 64.69 ? 9.71 years. Out of the total number of patients, 82.2% were male, of whom 75.2% suffered from hypertension. On invasive mechanical ventilation (IMV) were 93.7% of patients, and 92.1% were on vasopressor therapy. The average length of IMV until the beginning of CRRT was 4.65 ? 4 .57 days. In the first 24 hrs after starting IMV, 60% of patients had to undergo CRRT. Before administering CRRT, the average Simplified Acute Physiology Score II was 39.13 ? 14.45, creatinine 312 ?mol/L [Interquartile Range (IQR) 208.0?437.5], procalcitonin 2.70 ng/L (IQR 0.62?7.20), while 10.9% of patients had SpO2/FiO2 index > 200 and 41.6% had anuria. The mean number of procedures was 2.01 ? 1.36. The most frequent modality was hemodiafiltration in 67.3% of patients, and 46% used the oXiris? membrane. Using binary logistic regression, including demographic parameters, comorbidities, as well as clinical parameters before CRRT, it was found that patients with previous kidney disease were 3.43 times more susceptible to developing AKI, and patients with SpO2/FiO2 index ? 200 were 69% less susceptible to developing AKI/AKI on CKD requiring CRRT in the first 24 hrs from the start of IMV. Conclusion. Determining the risk factors for AKI/AKI on CKD is important for planning the prevention of these conditions that require the application of CRRT with the correct choice of dialysis modality and dose, membrane/filter type, and anticoagulant dose.

A Nursing Experience of Using Shared Decision Making to Care an End-Stage Renal Disease Patient Facing the Choice of Dialysis Modality

<p>本文探討一位末期腎病於門診長期追蹤，突發心臟問題導致腎功能急速惡化，需長期透析治療之病人，面對健康狀況改變引發抉擇衝突之護理過程。於2020.12.15至2021.01.06，藉由觀察、會談、Gordon 11項功能性健康型態及身體評估等方式收集資料，歸納病人有抉擇衝突、營養少於身體所需、潛在危險性感染、及知識缺失之健康問題。過程中予以鼓勵、傾聽、支持，提供多元化衛教方式，增加對透析的認識，以醫病共享決策（Shared Decision Making, SDM）介入，協助病人依照意願選擇腹膜透析，成功學會居家治療方式及自我照顧。建議日後慢性腎臟病於門診追蹤時，醫護團隊提早計畫性介入SDM，提供相關識能及足夠時間讓病人及家屬做討論，及早思考，接受治療。</p> <p> </p><p>The nursing process of a patient facing conflicting choices caused by changes in health status who had chronic kidney disease with regular follow-up in an outpatient clinic and suddenly got cardiac problem leading to a rapid deterioration of renal function and thus required long-term dialysis treatment. From December 15th, 2020 to January 1st, 2021, the relevant data was collected through observation, interviews, and physical assessment by Gordon’s 11 Functional Health Patterns and conclude that this case have healthy issues of conflicting choices, less nutrition than physical needs, potentially dangerous infections, and knowledge deficit. In the process, nursing cares were provided through encouragement, listening, supporting, and providing diversified health education methods to increase knowledge of dialysis. Use shared decision making (SDM) to intervene and assist the patient to choose peritoneal dialysis according to personal wishes, and help the patient successfully learn home dialysis and self-care. In the future, it is recommended that when chronic kidney disease patients are follow-up in outpatient clinics, the medical team should plan in advance to intervene with SDM to provide relevant knowledge and leave enough time for patients and their families to discuss and think early for receiving treatment.</p> <p> </p>

Do we practice what we preach? Dialysis modality choice among healthcare workers in the United Kingdom.

In the United Kingdom, over 80% of end-stage kidney disease patients receive in-center hemodialysis. We conducted a survey of UK renal healthcare workers on their preferred dialysis modality if they needed dialysis themselves. An anonymized online survey was disseminated to all renal healthcare workers in the United Kingdom. We asked "Assume you are an otherwise well 40-year-old (and, separately, 75-year-old) person approaching end stage kidney disease, you have no living kidney donor options at present. There are no contraindications to any dialysis options. Which dialysis therapy would you choose?" We also asked about factors influencing their choice. 858 individuals with a median age of 44.3 years responded. 70.2% were female, 37.4% doctors, and 31.1% were senior nurses. There was a preference for peritoneal dialysis over in-center hemodialysis (50.47% v. 6.18%; p< 0.001 for 40-year-old and 49.18% v. 17.83%; p< 0.001 for 75-year-old assumption) and home hemodialysis (50.47% v. 39.28%; p< 0.001 for 40-year-old and 49.18% v. 18.41% for 75-year-old assumption). There was a preference for home hemodialysis over in-center hemodialysis for 40-year-old (39.28% v. 6.18%; p< 0.001) but not for 75-year-old. On logistic regression, senior doctors were more likely to opt for PD when compared to nurses. Nurses, allied healthcare professionals, and those of Asian/British Asian ethnicity were more likely to choose in-center hemodialysis. Most healthcare workers in renal medicine would choose home-based treatment for themselves although the majority of end-stage kidney disease patients receive in-center hemodialysis in the United Kingdom; the reasons for the discrepancy need to be explored.

In-Center Hemodialysis vs. Home Dialysis: Comparison of Choice of Dialysis Modality

In-Center Hemodialysis vs. Home Dialysis: Comparison of Choice of Dialysis Modality

Effects of one-hour discussion on the choice of dialysis modality at the outpatient clinic: A retrospective cohort study using propensity score matching.

The aim of present study was to evaluate the effects of one-hour discussion on the choice of dialysis modality at the outpatient clinic. Charts of consecutive patients who had started maintenance dialysis from May 2013 to April 2021 were retrospectively reviewed. Characteristics at the start of dialysis were compared between patients participated and not participated in the discussion. Of the 620 incident dialysis patients, 128 patients had participated in the discussion. After propensity score matching (1:1), 127 patients who participated in the discussion tended to have fewer urgent hospitalizations (13.4% vs. 21.3%, p=0.068). In addition, more patients who initiated peritoneal dialysis (PD) (30.7% vs. 9.4%, p < 0.001). On multivariate analysis, participation in the discussion (OR 4.81, 95% CI 2.807-8.24; p < 0.001) was related to PD initiation. One-hour discussion on the choice of dialysis modality may increase PD initiations and decrease the number of urgent hospitalizations.

Impact of dialysis modality choice on the survival of end-stage renal disease patients with congestive heart failure in southern China: A retrospective cohort study.

Heart failure is one of the common complications in patients with end-stage renal disease (ESRD) and a major cause of death in these patients. The choice of dialysis modality for ESRD patients with congestive heart failure (CHF) is still inconclusive. The purpose of this study was to compare the prognosis of hemodialysis (HD) and peritoneal dialysis (PD) among ESRD patients with CHF and provide a basis for clinical decision-making. This was a retrospective study conducted at Guangdong Provincial Hospital of Traditional Chinese Medicine that included patients with CHF requiring long-term renal replacement therapy between January 1, 2012 and December 31, 2017. The end of follow-up was December 31, 2020. All patients were divided into HD and PD groups and sub grouped by age, and we used univariate and multifactorial Cox regression analyses to calculate the relative hazard ratios (HR) of the different dialysis types and adjusted for differences in baseline data using propensity score matching (PSM). A total of 121 patients with PD and 156 patients with HD were included in this study. Among younger ESRD patients (≤65 years of age) with CHF, the prognosis of HD was worse than that of PD [HR = 1.84, 95% confidence interval (CI) = 1.01-3.34], and this disadvantage remained significant in the fully adjusted model [sex, age at dialysis initiation, Charlson comorbidities index, body mass index, prealbumin, hemoglobin, and left ventricular ejection fraction (LVEF)] and after PSM. In the older group (>65 years of age), the prognosis of HD was better than that of PD (HR = 0.46, 95% CI = 0.25-0.85), and the protective effect remained in the fully adjusted model and after PSM. The aforementioned survival differences across the cohort were maintained in patients with preserved LVEF (>55%), but could not be reproduced in patients with reduced LVEF (≤55%). In southern China, PD is a better choice for younger patients with ESRD, CHF and preserved LVEF, and HD is the better option for older patients.

Chronic Kidney Disease and Nephrology Care in People Living with HIV in Central/Eastern Europe and Neighbouring Countries-Cross-Sectional Analysis from the ECEE Network.

Chronic kidney disease (CKD) is a significant cause of morbidity and mortality among patients infected with human immunodeficiency virus (HIV). The Central and East Europe (CEE) region consists of countries with highly diversified HIV epidemics, health care systems and socioeconomic status. The aim of the present study was to describe variations in CKD burden and care between countries. The Euroguidelines in the CEE Network Group includes 19 countries and was initiated to improve the standard of care for HIV infection in the region. Information on kidney care in HIV-positive patients was collected through online surveys sent to all members of the Network Group. Almost all centres use regular screening for CKD in all HIV (+) patients. Basic diagnostic tests for kidney function are available in the majority of centres. The most commonly used method for eGFR calculation is the Cockcroft–Gault equation. Nephrology consultation is available in all centres. The median frequency of CKD was 5% and the main cause was comorbidity. Haemodialysis was the only modality of treatment for kidney failure available in all ECEE countries. Only 39% of centres declared that all treatment options are available for HIV+ patients. The most commonly indicated barrier in kidney care was patients’ noncompliance. In the CEE region, people living with HIV have full access to screening for kidney disease but there are important limitations in treatment. The choice of dialysis modality and access to kidney transplantation are limited. The main burden of kidney disease is unrelated to HIV infection. Patient care can be significantly improved by addressing noncompliance.

Patients’ perspectives of home and self-assist haemodialysis and factors influencing dialysis choices in Singapore

BackgroundThe rise in end stage kidney disease (ESKD) prevalence globally calls for a need to deliver quality and cost-effective dialysis. While most are familiar with centre-based haemodialysis (HD), there is a move to increase uptake of home-based modalities (peritoneal dialysis (PD) or home haemodialysis (HHD)) and self-assist haemodialysis (SAHD) due to the economic, clinical and lifestyle advantages they confer. However, HHD and SAHD are not yet widely adopted in Singapore with majority of patients receiving in-centre HD. Although much research has examined patient decision-making around dialysis modality selection, there is limited literature evaluating patient’s perspectives of HHD and SAHD in Asia where the prevalence of these alternative modalities remained low. With this background, we aimed to evaluate patient’s perspectives of HHD and SAHD and the factors influencing their choice of dialysis modality in Singapore to determine the challenges and facilitators to establishing these modalities locally.MethodsSemi-structured interviews were conducted with 17 patients on dialysis from a tertiary hospital in Singapore in this exploratory qualitative study. Data collected from one-to-one interviews were analysed via thematic content analysis and reported via an interpretative approach.ResultsThe findings were segregated into: (1) factors influencing choices of dialysis modality; (2) perspectives of HHD; and (3) perspectives of SAHD. Modality choices were affected by environmental, personal, social, financial, information and family-related factors. Most perceived HHD as providing greater autonomy, convenience and flexibility while SAHD was perceived as a safer option than HHD. For both modalities, patients were concerned about self-care and burdening their family.ConclusionsThe findings provided a framework for healthcare providers to understand the determinants affecting patients’ dialysis modality decisions and uncovered the facilitators and challenges to be addressed to establish HHD and SAHD modalities in Singapore.

First-year mortality in incident dialysis patients: results of the Peridialysis study

BackgroundControversy surrounds which factors are important for predicting early mortality after dialysis initiation (DI). We investigated associations of predialysis course and circumstances affecting planning and execution of DI with mortality following DI.MethodsAmong 1580 patients participating in the Peridialysis study, a study of causes and timing of DI, we registered features of predialysis course, clinical and biochemical data at DI, incidence of unplanned suboptimal DI, contraindications to peritoneal dialysis (PD) or hemodialysis (HD), and modality preference, actual choice, and cause of modality choice. Patients were followed for 12 months or until transplantation. A flexible parametric model was used to identify independent factors associated with all-cause mortality.ResultsFirst-year mortality was 19.33%. Independent factors predicting death were high age, comorbidity, clinical contraindications to PD or HD, suboptimal DI, high eGFR, low serum albumin, hyperphosphatemia, high C-reactive protein, signs of overhydration and cerebral symptoms at DI. Among 1061 (67.2%) patients who could select dialysis modality based on personal choice, 654 (61.6%) chose PD, 368 (34.7%) center HD and 39 (3.7%) home HD. The 12-months survival did not differ significantly between patients receiving PD and in-center HD.ConclusionsFirst-year mortality in incident dialysis patients was in addition to high age and comorbidity, associated with clinical contraindications to PD or HD, clinical symptoms, hyperphosphatemia, inflammation, and suboptimal DI. In patients with a “free” choice of dialysis modality based on their personal preferences, PD and in-center HD led to broadly similar short-term outcomes.

Patients with end-stage renal disease and diabetes had similar survival rates whether they received hemodialysis or peritoneal dialysis.

The survival rate of patients with diabetes mellitus (DM) and end-stage renal disease (ESRD) undergoing maintenance dialysis, including hemodialysis (HD) and peritoneal dialysis (PD), is markedly lower than that observed in patients with ESRD without DM. We used propensity score matching to balance the clinical characteristics of patients from the HD and PD groups. We compared the survival rate between HD or PD, followed by Cox regression analyses accounting for age, Charlson comorbidity index (CCI), body mass index (BMI), and serum albumin levels to examine the outcome influence of dialysis modalities. During follow-up, there were 19 (18.1%) and 18 (17.1%) deaths among patients who underwent HD and PD, respectively (P=0.856). Kaplan-Meier survival analyses showed no significant difference in overall survival between patients in the HD and PD groups. Cox regression analyses stratified based on age, CCI, BMI, and serum albumin demonstrated that the choice of HD over PD did not influence survival. Regardless of age, CCI, BMI, and albumin level, patients with DM and ESRD had similar survival rates whether they received HD or PD in China. The choice of dialysis modality should be individualized according to patients' physical status and local practices for patients with DM and ESRD.

Super-Minimal Incision Technique in Pediatric Kidney Transplantation: A Paired Kidney Analysis.

BackgroundRecently, the demand for minimally invasive techniques in kidney transplantation (MIKT) has increased. However, there is only a limited number of studies on MIKT, especially in pediatric kidney transplants. Hence, we evaluated whether there is a difference between the super-minimal incision technique in pediatric kidney transplantation (SMIPKT) and conventional kidney transplantation (CKT).MethodsBetween December 2018 and November 2021, 34 patients who underwent pediatric kidney transplantation with a follow-up of 1 month were enrolled. A paired kidney analysis was performed to minimize donor variability and bias. The SMIPKT and CKT groups included 17 patients.ResultsThere was no difference in baseline clinical characteristics, including age, sex, the donor/ recipient weight ratio (DRWR), choice of dialysis modality, pretransplant dialysis time, BMI, renal artery number, cause of ESRD, DGF, length of the kidney and cold ischemic time, tacrolimus concentration at 3 and 7 days, serum creatinine at 1 month and postoperative complication rate between the SMIPKT and CKT groups (all P > 0.05). However, the length of the incision, operation time, intraoperative bleeding, postoperative drainage volume within 24 h and Vancouver scar scale at 1 month were statistically significant (all P < 0.05).ConclusionCompared with CKT, our results indicated that SMIPKT showed more satisfactory cosmetic results, shorter SMIPKT operating time, and reduced intraoperative bleeding and postoperative drainage volume within 24 h. There were also no statistical differences in postoperative complications. Hence, we suggest that SMIPKT is an appropriate method for pediatric kidney transplantation.