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Clinical Decisionmaking

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Physicians should give patients with kidney failure more information about the option of peritoneal dialysis

Few donor kidneys are available for transplantation in patients with kidney failure, also called end-stage renal disease (ESRD). Thus, most of these patients must chose between hemodialysis and peritoneal dialysis, procedures that remove toxins or wastes from the blood that the failed kidney can no longer remove.

Patients rate peritoneal dialysis care higher than hemodialysis care, according to a study supported in part by the Agency for Healthcare Research and Quality (HS08365). Since both approaches are effective in replacing kidney function, clinicians should give ESRD patients more information about the option of peritoneal dialysis, suggests lead author Haya R. Rubin, M.D., of Johns Hopkins University.

Patients who undergo hemodialysis usually must go to an outpatient dialysis facility three times a week for 3 to 4 hours each time. There, trained nurses and technicians carry out the prescribed treatment using a dialysis machine. In contrast, peritoneal dialysis is most commonly performed every day at home by the patient after he or she is trained by dialysis facility staff. Peritoneal dialysis can even be done at night while the patient is asleep.

In this study, the investigators examined patient satisfaction using survey responses from 656 patients an average of 7 weeks after starting dialysis at one of 37 dialysis centers participating in the Choices for Healthy Outcomes in Caring for End-stage Renal Disease (CHOICE) study, a national multicenter study of dialysis outcomes (Neil R. Powe, M.D., principal investigator). Patients receiving peritoneal dialysis were much more likely than those receiving hemodialysis to give excellent ratings of dialysis care overall (85 vs. 56 percent), and they were significantly more likely to give excellent ratings for each specific aspect of care rated. These differences were not reduced after adjustment for patient characteristics, distance from the dialysis center, or time since starting dialysis.

See "Patient ratings of dialysis care with peritoneal dialysis vs. hemodialysis," by Dr. Rubin, Nancy E. Fink, M.P.H., Laura C. Plantinga, Sc.M., and others, in the February 11, 2004, Journal of the American Medical Association 291(6), pp. 697-703.

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