Am Fam Physician. 2004;70(10):1987-1988
On a day-to-day basis, peritoneal dialysis is as effective as hemodialysis, and studies have found either no differences in mortality between the two modalities or better survival rates with peritoneal dialysis. Hemodialysis requires traveling to a facility three times a week; peritoneal dialysis can be performed daily at home, either manually or using an automated system. Rubin and colleagues sought to determine patient preferences by comparing evaluations of patients receiving different types of dialysis treatment.
The Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) study prospectively enrolled patients at 81 dialysis centers who had initiated outpatient dialysis within the previous three months. Measures included a validated, chart-based comorbidity and severity-of-illness measure, health status measures, and self-administered questionnaires to assess patient evaluations and satisfaction with care.
There were 336 eligible hemodialysis respondents and 185 peritoneal dialysis respondents. The best-rated unadjusted items were similar in the two groups: caring and concern of nurses, caring and concern of dialysis center staff, response to pain, and availability in emergency. The two groups also agreed on four of the five worst-rated items: coordination among nephrologists and other doctors, how often the nephrologist sees the patient, the amount of fluid removed during dialysis, and the accuracy of information received from nephrologists.
Peritoneal dialysis patients also rated the ease of reaching the nephrologist among the worst-rated items, and the hemodialysis patients included the amount of information given to help them choose hemodialysis or peritoneal dialysis. Patients undergoing peritoneal dialysis rated their care much higher than hemodialysis patients rated their care, with 85 percent of the former group rating overall care as excellent compared with 56 percent of hemodialysis patients. The greatest differences were found in the items “information given to help choose modality” and “amount of dialysis information from staff.” After adjustment, peritoneal dialysis patients gave higher ratings to all 23 survey items. This difference held in sensitivity and subgroup analyses.
Peritoneal dialysis patients were 1.5 times more likely to rate their dialysis care as excellent overall than were hemodialysis patients, regardless of demographic and health status characteristics. In particular, peritoneal dialysis patients rated the information allowing them to choose between modalities much higher than hemodialysis patients did.
Peritoneal dialysis may be less costly than hemodialysis, but physicians may prefer hemodialysis because of reimbursement trends. Planned payment policies would have to adapt to allow the cost savings that could be realized if more patients were to choose peritoneal dialysis. This study indicates that peritoneal dialysis is associated with greater patient satisfaction.