TREATMENT MODALITY SELECTION IN 150 CONSECUTIVE PATIENTS STARTING ESRD THERAPY

Objective: The purpose of this study was to assess the reasons for tre atment modality selection between hemodialysis (HD) and peritoneal dia lysis (PD) in 150 consecutive patients in a single center. Design: Thi s study is a retrospective study using chart review as the data collec tion method. Setting: A single tertiary care university teaching hospi tal. Patients: One hundred and fifty consecutive patients starting end -stage renal disease (ESRD) therapy at the Royal Victoria Hospital in Montreal were assessed. Their treatment modality at 6 weeks after star ting dialysis was recorded as their treatment modality. Patients trans planted or who died prior to that 6 week period were excluded. Main Ou tcome Measures: The treatment modality, that is, either HD or PD, at 6 weeks after the initiation of ESRD was the modality assigned to the p atient. Results: One hundred and fifty patients started ESRD therapy o f whom 83 went to HD and 67 to PD. Thirty-one patients were directed t o HD, including 20 for social reasons, 3 with ostomies, and 6 with uns uitable abdomens. Fourteen patients were directed to PD, including 10 with severe cardiovascular disease, 3 with no vascular access, and one for geographical reasons. Of 31 diabetics who were encouraged to do P D, 17 went to PD and 14 to HD (10 for social reasons, 3 refused PD, an d one with an inappropriate abdomen). Seventy-four patients were initi ally eligible for either PD or HD. Fifty percent (37) went to PD and 5 0% to HD. Of those going to HD, 15 went to self-care HD, of whom 7 had prior exposure to HD. Eleven were not informed regarding PD. There wa s no gender preference for PD versus HD. Conclusion: We conclude that among informed patients, if given a choice of treatment modality, the majority will choose self-care dialysis including continuous ambulator y peritoneal dialysis (CAPD) or self-care HD.