People With Kidney Failure Rate Peritoneal Dialysis Higher Than Hemodialysis
]]>Kidney failure]]> affects more than 375,000 people in the United States. Kidney failure occurs when the kidneys are no longer able to adequately filter out excess fluid and wastes from the blood. Most people who go into kidney failure have experienced diminishing kidney function for quite some time, often as a result of life-long diabetes or high blood pressure.
Since the number of organ donors available for ]]>kidney transplantation]]> is limited, most people with kidney failure are treated with ]]>dialysis]]> , a method of removing waste products and extra fluid from the blood when the kidneys are no longer able to.
There are two types of dialysis: hemodialysis and peritoneal dialysis. Hemodialysis involves filtering the blood through veins in the arm, leg, or neck and is usually performed in a clinical setting. Patients typically spend several hours in the dialysis center, three or four times a week for their treatment. Peritoneal dialysis, on the other hand, involves filtering the blood through the peritoneum, which is a membrane that surrounds and supports the abdominal organs. Peritoneal dialysis has the advantage of self-administration at home. For most patients, both types of dialysis are equally effective, so people with kidney failure and their physicians often must choose between the two.
A study published in the February 11, 2004 Journal of the American Medical Association found that people receiving peritoneal dialysis were more satisfied with their care than those receiving hemodialysis.
About the Study
This study included 521 people with kidney failure who recently began receiving dialysis. About two-thirds (64%) were receiving hemodialysis and about one-third (36%) were receiving peritoneal dialysis. The participants were part of the Choices for Health Outcomes in Caring for End-stage Renal Disease (CHOICE) study, a multicenter study on dialysis.
After approximately seven weeks of dialysis, the participants completed a questionnaire to rate their satisfaction with care received from their physician, care received from the dialysis staff, as well as overall care. In addition, the researchers tracked the participants’ illness severity and coexisting diseases.
Participants receiving peritoneal dialysis were more likely than those receiving hemodialysis to rate their care as excellent, both overall and for each specific aspect of care rated. Specifically, overall care was rated excellent by 85% of those on peritoneal dialysis compared with 56% of those on hemodialysis.
Participants receiving peritoneal dialysis felt that they were better informed before choosing their type of dialysis: 69% of participants on peritoneal dialysis felt the amount of information they received was excellent, compared with only 26% of participants on hemodialysis.
Although these findings ought to influence the discussion dialysis patients have with their physicians, there are limitations to this study. First, peritoneal dialysis requires more active involvement; people who choose peritoneal dialysis may have a greater sense of control over their lives, which may translate to increased satisfaction with life in general. Second, this study measured satisfaction levels after an average of seven weeks on therapy, which may not reflect complications participants may experience down the road. Third, the higher satisfaction among those on peritoneal dialysis may be partly a consequence of the home dialysis setting and not the dialysis treatment itself.
How Does This Affect You?
This study suggests that if people were more informed about their options beforehand, many would choose peritoneal dialysis over hemodialysis. This supports previous research that found that more informed people choose peritoneal dialysis more often.
Despite that fact that most health care professionals support greater use of peritoneal dialysis in clinical practice, the percentage of people choosing peritoneal dialysis has been declining in recent years. While lack of information may be one reason for this trend, it’s important to note that approximately 20% of these patients are not candidates for this type of dialysis, usually due to abdominal problems, physical disabilities, or psychological challenges.
This study highlights the importance of being adequately informed about medical treatment options. People who are at risk for kidney failure should discuss dialysis with their physician early on, so that if kidney failure occurs they are educated about their options. Early planning and referral to a specialist is especially important for peritoneal dialysis, which takes longer to initiate than hemodialysis.
National Institute of Diabetes and Digestive and Kidney Diseases
National Kidney Foundation
Rubin HR, Fink NE, et al. Patient Ratings of Dialysis Care With Peritoneal Dialysis vs Hemodialysis. JAMA . 2004;291:697-703.
Heaf J. Underutilization of Peritoneal Dialysis. JAMA. 2004;291:740-742.
Last reviewed Feb 12, 2004 by ]]>Richard Glickman-Simon, MD]]>
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