NDT Advance Access published online on August 28, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn484
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A prospective evaluation of renal replacement therapy modality eligibility
1 Humber River Regional Hospital, University of Toronto, Toronto, Ontario, Canada 2 Astellas Pharma US, Deerfield, IL, USA 3 Dalhousie University, Halifax, Nova Scotia, Canada 4 Nephrology Associates, Birmingham, AL, USA 5 McGill University, Montreal, Quebec, Canada 6 Brigham and Women's Hospital, Boston, MA 7 Baxter Healthcare Corporation, McGaw Park, IL 8 Hospital of St. Raphael, New Haven, CT, USA
Correspondence and offprint requests to: David C. Mendelssohn, Division of Nephrology and Medical Director of Dialysis, Humber River Regional Hospital, University of Toronto, 200 Church St. Room 2024, Weston, Ontario, M9N 1N8, Canada. Tel: +1-416-243-4368; Fax: +1-416-243-4421; E-mail: dmendelssohn{at}hrrh.on.ca
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Abstract |
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Background. Patient eligibility for renal replacement therapy (RRT) modalities is frequently debated, but little prospective data are available from large patient cohorts.
Methods. We prospectively evaluated medical and psychosocial eligibility for the three RRT modalities in patients with chronic kidney disease (CKD) stages III–V who were enrolled in an ongoing prospective cohort study conducted at seven North American nephrology practices.
Results. Ninety-eight percent of patients were considered medically eligible for haemodialysis (HD), 87% of patients were assessed as medically eligible for peritoneal dialysis (PD) and 54% of patients were judged medically eligible for transplant. Age was the leading cause of non-eligibility for both PD and transplant. Anatomical concerns (adhesions, hernias) were the second most frequent concern for PD eligibility followed by weight. Weight was also a concern for transplant eligibility. The proportion of patients medically eligible for RRT did not vary by CKD stage. There was, however, significant inter-centre variation in the proportion of patients medically eligible for PD and transplant. Ninety-five percent of patients were considered psychosocially eligible for HD, 83% of patients were assessed as psychosocially eligible for PD and 71% of patients were judged psychosocially eligible for transplant. The percentage of patients who were assessed as having neither medical nor psychosocial contraindications for RRT was 95% for HD, 78% for PD and 53% for transplant.
Conclusions. Most CKD patients are considered by their medical care providers to be suitable for PD. Enhanced patient education, promotion of home dialysis for suitable patients and empowerment of patient choice are expected to augment growth of home dialysis modalities.
Keywords: eligibility; haemodialysis; peritoneal dialysis; transplantation
Received for publication: 22. 1.08
Accepted in revised form: 5. 8.08
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  D. C. Mendelssohn INCREASING PD UTILIZATION: SHOULD SUITABLE PATIENTS BE FORCED? Perit. Dial. Int., March 1, 2009; 29(2): 144 - 146. [Full Text] [PDF]
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