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Trade-offs and individual preferences should be emphasized when advising patients about dialysis choices

About 90,000 patients a year develop end-stage renal disease and, due to the limited availability of kidney transplants, must begin renal replacement therapy via hemodialysis (HD) or peritoneal dialysis (PD). HD is usually performed at a dialysis center, and PD, which is chosen as initial therapy by fewer than 10 percent of patients, is usually performed at home.

Contrary to anecdotal reports, PD does not seem to produce a better quality of life than HD, according to a recent study that was supported in part by the Agency for Healthcare Research and Quality (HS08365). In the study, some dialysis-specific aspects of quality of life were better among HD patients, and others were better among PD patients.

Researchers from Johns Hopkins University, Tufts-New England Medical Center, and Yale conducted a large-scale prospective study of changes in quality of life scores and overall health status over a 1-year period from the start of dialysis in 698 HD and 230 PD patients. Patients were enrolled at 81 outpatient dialysis units in 19 States from 1995 to 1998. At the 1-year followup, both PD and HD patients reported improvements in nearly all aspects of general functioning and psychologic well-being. The surprising finding was that patients on HD improved more on aspects of general health-related quality of life than patients on PD, with greater improvements in physical functioning and general health perceptions.

Changes in dialysis-specific aspects of quality of life were more mixed, and there were more differences between the two groups. HD patients improved more in some aspects, such as sleep (which for PD patients actually became worse over time), body image, and sexual functioning than those on PD. PD patients improved more on other dialysis-specific aspects of quality of life, such as financial well-being, and they continued to have higher scores for ability to travel, diet, and dialysis access.

See "Changes in quality of life during hemodialysis and peritoneal dialysis treatment: Generic and disease specific measures," by Albert W. Wu, M.D., M.P.H., Nancy E. Fink, M.P.H., Jane V.R. Marsh-Manzi, and others, in the Journal of the American Society of Nephrology 15, pp. 743-753, 2004.

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