NDT Advance Access originally published online on July 4, 2006
Nephrology Dialysis Transplantation 2006 21(10):2814-2820; doi:10.1093/ndt/gfl339
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Starting and withdrawing haemodialysis—associations between nephrologists' opinions, patient characteristics and practice patterns (data from the Dialysis Outcomes and Practice Patterns Study)
1Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, UK 2Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA 3Universita Federico II, Naples, Italy and 4Nephrology Department, Lapeyonie University Hospital, Montpellier, France and 5Veterans Affairs Medical Centre/University of Michigan, Ann Arbor, MI, USA
Correspondence and offprint requests to: Friedrich K. Port, MD, Arbor Research Collaborative for Health, 315 W. Huron, Suite 360, Ann Arbor, MI 48103, USA. Email: friedrich.port{at}ArborResearch.org
Background. The incidence and prevalence of haemodialysis vary widely across countries. The variation may be attributable to differences in the incidence of end-stage renal disease and/or in the availability of haemodialysis. Previous studies have identified differences in nephrologists’ opinions about the availability of haemodialysis and its appropriateness for patients with comorbidities. We studied the associations between nephrologists’ opinions, availability of haemodialysis, patient characteristics and comorbidities, and facilities’ withdrawal rates.
Methods. Most of our analyses used data from 242 haemodialysis units in six countries (France, Germany, Italy, Spain, UK and the USA) in the first phase of the Dialysis Outcomes and Practice Patterns Study (DOPPS I). Opinions about access to and practice patterns in dialysis facilities, measured by the level of agreement with standardized statements, were collected from medical directors and nurse managers. A sub-analysis considered data from corresponding facilities in DOPPS II.
Results. We found wide variations in the prevalence of waiting lists for new dialysis patients (UK 60%; USA 25%; Germany 0%; P < 0.05), in agreement with starting haemodialysis for patients with advanced age, dementia and comorbidities (UK, France < USA < other countries; P < 0.05), and in agreement with withdrawing dialysis (other countries < UK/USA; P < 0.05). The estimated glomerular filtration rate at the start of dialysis was not significantly different in units with waiting lists. Significant associations were found between nephrologists’ opinions and the odds of patients being 
80 years old, and between opinions and the rate and relative risk of withdrawal of haemodialysis. No significant associations were found between opinions and patients’ comorbidities or dependency.
Conclusion. Differences within and across countries in nephrologists’ opinions regarding starting and withdrawing haemodialysis reflect differences in access to haemodialysis and the practice of withdrawal of haemodialysis in their facilities.
Keywords: access to haemodialysis; Dialysis Outcomes and Practice Patterns Study (DOPPS); end-stage renal disease; practice patterns; withdrawal of dialysis
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