Background: In the Philippines, 86% of incident dialysis patients are started on hemodialysis (HD) and 14% are treated with peritoneal dialysis (PD), representing a decline over a 2-year period. One important factor which affects patients’ choice of dialysis modality is the input of their physicians. Our objective was to identify the factors affecting attitudes and recommendations of Filipino nephrologists regarding HD and PD. Methods: Attendees of the annual national nephrology meeting completed an anonymous self-administered questionnaire. Results: Respondents were heavily involved in clinical dialysis work, and 86.7% had most/all of their patients on HD. Recommendations about dialysis modality were based most strongly on overall cost to patient (4.4 on a scale of 1 [not important] to 5 [most important], residual renal function (RRF) preservation (4.4), patient preference (4.3) availability of dialysis support staff (4.3), and comparative quality of life data (4.3). Least important was physician reimbursement (2.8). Patient-related factors favoring HD were: poor personal hygiene, impaired vision and manual dexterity; while favoring PD were: age <10 years, living far from HD unit, and the availability of trainable family members. When asked which modality they would recommend to an equally eligible patient, 49.2% responded they would not recommend either modality and would allow the patient to choose, while 40.7% would recommend HD and 10.2% would recommend PD. Conclusion: Respondents consider overall cost and RRF preservation as the most important factors in dialysis modality selection, yet only 10.2% would recommend PD as first choice. It is likely that factors other than those addressed in the survey are stronger determinants of the patient’s final choice of modality.

Keywords:
Dialysis practice pattern, End-stage renal disease, Hemodialysis, Modality distribution, Peritoneal dialysis, Survey
1.
US Renal Data System: USRDS 2008 Annual Data Report. Bethesda, National Institutes of Health, Department of Health and Human Services, 2008.
2.
Cecka JM, Cohen B, Rosendale J, et al: Could more effective use of kidneys recovered from older deceased donors result in more kidney transplants for older patients? Transplantation 2006;81:966–970.
3.
Philippine Renal Disease Registry: PRDR 2005 Annual Data Report. Quezon City/Philippines, Renal Disease Control Program, Department of Health, 2005.
4.
Nayak KS: Asia, a melting pot for peritoneal dialysis practices: redefining and expanding peritoneal dialysis horizons in Asia. Perit Dial Int 2004;24:422–423.
5.
Vonesh EF, Snyder JJ, Foley RN, et al: Mortality studies comparing peritoneal dialysis and hemodialysis: What do they tell us? Kidney Int 2006;70:S3–S11.
6.
Vonesh EF, Moran J: Mortality in end-stage renal disease: a reassessment of differences between patients treated with hemodialysis and peritoneal dialysis. J Am Soc Nephrol 1999;10:354–365.
7.
Jaar BG, Coresh J, Plantinga LC, et al: Comparing the risk for death with peritoneal dialysis and hemodialysis in a national cohort of patients with chronic kidney disease. Ann Intern Med 2005;143:174–183.
8.
Wuerth DB, Finkelstein SH, Schwetz O, et al: Patients’ descriptions of specific factors leading to modality selection of chronic peritoneal dialysis or hemodialysis. Perit Dial Int 2002;22:184–190.
9.
Jager KJ, Korevaar JC, Dekker FW, et al: The effect of contraindications and patient preference on dialysis modality selection in ESRD patients in the Netherlands. Am J Kidney Dis 2004;43:891–899.
10.
Mendelssohn DC, Mullaney SR, Jung B, et al: What do American nephrologists think about dialysis modality selection. Am J Kidney Dis 2001;37:22–29.
11.
Jung B, Blake PG, Mehta RL, et al: Attitudes of Canadian nephrologists toward dialysis modality selection. Perit Dial Int 1999;19:263–268.
12.
Charest AF, Mendelssohn DC: Are North American nephrologists biased against peritoneal dialysis? Perit Dial Int 2001;21:335–337.
13.
Blake PG: The complex economics of modality selection. Perit Dial Int 2004;24:538–541.
14.
Jassal S, Krishna G, Mallick N, et al: Attitudes of British Isles nephrologists towards dialysis modality selection: a questionnaire study. Nephrol Dial Transplant 2002;17:474–477.
15.
Kuno T, Matsumoto K: Clinical benefit of preserving residual renal function in patients after initiation of dialysis. Blood Purif 2004;22(suppl 2):67–71.
16.
Chandna S, Farrington K: Residual renal function: considerations on its importance and preservation in dialysis patients. Semin Dial 2004;17:196–201.
17.
Sennfalt K, Magnusson M, Carlsson P: Comparison of hemodialysis and peritoneal dialysis – a cost-utility analysis. Perit Dial Int 2002;22:39–47.
18.
Mahajan S, Tiwari S, Kalra V, et al: Factors affecting the use of peritoneal dialysis among the ESRD population in India: a single-center study. Perit Dial Int 2004;24:538–541.
19.
Li PKT, Chow KM: The cost barrier to peritoneal dialysis in the developing world – an Asian perspective. Perit Dial Int 2001;21:S307–S313.
20.
Lee H, Manns B, Taub K, et al: Cost analysis of ongoing care of patients with end-stage renal disease: the impact of dialysis modality and dialysis access. Am J Kidney Dis 2002;40:611–622.
21.
Prichard SS: Treatment modality selection in 150 consecutive patients starting ESRD therapy. Perit Dial Int 1996;16:69–72.
22.
Little J, Irwin A, Marshall T, et al: Predicting a patient’s choice of dialysis modality: experience in a United Kingdom renal department. Am J Kidney Dis 2001;37:981–986.
23.
Troidle L, Kliger A, Finkelstein F: Barriers to utilization of chronic peritoneal dialysis in network #1, New England. Perit Dial Int 2006;26:452–457.
24.
Blake PG, Finkelstein FO: Why is the proportion of patients doing peritoneal dialysis declining in North America? Perit Dial Int 2001;21:107–114.
25.
Lo WK, Li FK, Choy CBY, et al: A retrospective survey of attitudes toward acceptance of peritoneal dialysis in Chinese end-stage renal failure patients in Hong Kong – from a cultural point of view. Perit Dial Int 2001;21:S318–S321.
© 2011 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.