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:
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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