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Dialysis patients are more likely to accept a higher dose of dialysis than to switch dialysis mode to increase survival

Because of the limited number of donor kidneys, most patients with end-stage renal disease must undergo dialysis. Hemodialysis (HD) must be done at a hemodialysis site three times a week, whereas peritoneal dialysis (PD) can be done daily at home. Dialysis patients have strong preferences for their current mode of dialysis. For instance, they are more likely to accept a higher dose of dialysis than to switch modality to increase survival, according to a study supported in part by the Agency for Healthcare Research and Quality (HS08365).

For the study, researchers interviewed 109 patients on HD, 57 patients on continuous ambulatory PD (CAPD), and 22 patients on continuous cycling peritoneal dialysis (CCPD) from Maryland and Massachusetts. They asked patients about their preference for dialysis modality based on a time trade-off technique scaled between 0 (death) and 1 (perfect health). HD, CAPD, and CCPD patients had similar preference values for current health (mean, 0.69, 0.74, and 0.70, respectively), and lower preference values for alternative modalities (for example, mean of 0.55 assigned to CAPD by HD patients).

More than 75 percent of patients would choose a high dose over a lower dose of dialysis if it increased length of survival by 20 percent. However, more than 30 percent would not switch modality, even if it increased survival by 100 percent. The only patient characteristic associated with difference in preference values was depression. The researchers conclude that physicians should talk with patients about the modality and dose they prefer because preferences cannot be predicted by patient characteristics.

See "How strong are patients' preferences in choices between dialysis modalities and doses?" by Eric B. Bass, M.D., Stacey Wills, Ph.D., Nancy E. Fink, M.P.H., and others, in the October 2004 American Journal of Kidney Diseases 44(4), pp. 695-705.

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