Majority of Nephrology Professionals Prefer Home Dialysis

Throughout the world, the majority of patients receive dialysis at a dialysis center: 85 percent are treated in-center while the remaining 15 percent choose home dialysis. However, within the United States, home treatment is nearly nonexistent: 93 percent of patients choose in-center hemodialysis, only 7 percent receive peritoneal dialysis (PD) and less than 1 percent choose home hemodialysis (HHD). Considering that most nephrology professionals would prefer HHD and PD themselves, it raises the question as to why more patients do not choose home dialysis. This is despite the fact that many physicians believe that between 25-35 percent of patients would do better if they were on a home dialysis therapy.     

In 2009, an email questionnaire was sent to professionals within the nephrology community, and the responses of 44 nephrologists and 101 nurses were compiled. These specialists were asked what their treatment preferences were for end stage renal disease (ESRD). They were also asked to describe what type of dialysis they would choose for themselves if they needed to start dialysis and a kidney transplant was not going to be immediately available: 93 percent of nephrologists and 89 percent of nurses said they would choose home dialysis over in-center dialysis. And instead of being asked which treatment method they would choose for their patients, they were asked to put themselves in their patients’ shoes. They were instructed to imagine what choices they would make if they themselves had ESRD. The study was written up in an article, “Modality choice: Perceptions about renal replacement therapy among nephrology professionals,” for the September 2010 issue of Nephrology News & Issues. Here are some of its findings:

  • In one scenario, when they knew that they would not be able to get a transplant for three years, both physicians (50 percent) and nurses (45 percent) chose HHD over in-center dialysis. PD was chosen by 43 percent of physicians and 44 percent of nurses. However, that choice became even more pronounced when these caregivers were told that a kidney would never be available and that dialysis was going to be permanent: 96 percent of physicians and 89 percent of nurses chose home dialysis (Sixty-six percent of physicians and 49 percent of nurses thought HHD the best option, whereas 30 percent of physicians and 40 percent of nurses preferred PD second over in-center hemodialysis.).
  • It is interesting to note why HHD and PD were favored over in-center treatment. Thirty-six percent of the nephrology professionals polled chose the modality they did because of the flexibility that home dialysis has to offer, and 14 percent said they would want to be in charge of their own therapy. However, the number one benefit for choosing the treatment they did was that the modality had better outcomes (cited by 41 percent of respondents).
  • Based on the views of professionals in the nephrology community, the ability to perform home treatments does not seem to be a limiting issue because a majority of doctors and nurses said that 20 to 50 percent of patients would make good candidates for either HHD or PD.
  • Despite their preference for home dialysis — particularly HHD — nephrology professionals in the survey said patients should decide for themselves which treatment is right for them. Fifty percent of doctors polled stated that the choice should be left to the patient, with another 36 percent stating that the patient and the care team should make the decision together. Only 2 percent felt the choice should be left to the nephrologist.

Summary

A majority of health professionals within the nephrology community would prefer home dialysis over in-center dialysis. Among the reasons cited were not only more flexibility and control over their own therapy but — perhaps most importantly — better results. However, in the U.S., the number of dialysis patients who opt for home dialysis is few. Nephrology professionals believe that there are many current in-center patients who would be good candidates for home dialysis. Consider speaking with your doctor about the possibility of switching to HHD or PD; you might find it more convenient, more effective and less difficult to perform than you might imagine.

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