Attitudes of Canadian nephrologists toward dialysis modality selection

Objective:To determine the opinions and attitudes of Canadian nephrologists about dialysis modality decisions and optimal dialysis system design. Participants: Members of the Canadian Society of Nephrology. Intervention: A mailed survey questionnaire. Results: A 66% response rate was obtained. Decisions about modality are rep orted to be based most strongly on patient preference (4.4 an a scale from 1 to 5), followed by quality of life (4.06), morbidity (3.97), mortality (3 .85), and rehabilitation (3.69), while neither facility (1.78) nor physicia n (1.62) reimbursement are important. When asked about the current relative utilization of each modality, nephrologists felt that hospital-based hemod ialysis (HD) is slightly overutilized (2.53), continuous ambulatory periton eal dialysis (CAPD) is about right (3.00), while cycler peritoneal dialysis (PD) (3.53), community-based full (3.83) and self-care HD (3.91), and home HD (4.02) are underutilized. A hypothetical question about optimal distrib ution to maximize survival revealed that a type of HD should constitute 62. 8% of the mix, with more emphasis on cycler PD (14.90/b), community-based f ull care HD(13.8%), self-care HD(14.5%), and home HD (9.0%) than is current practice. However, when the goal was to maximize cost effectiveness, HD fe ll slightly to 57.8%. Conclusions:These survey results suggest that the current national average 66%/34% HD/PD ratio is reasonable. However, there appears to be a consensus that Canada could evolve to a more cost-effective, community-based dialysi s system without compromising patient outcomes.