Opinions regarding outcome differences in European and US haemodialysis patients

Study goal and design. The aim of this evaluation was to understand why out comes seem to be different in different parts of the world. Ln an attempt t o look at this question from a point of view other than that necessarily ad opted by epidemiological studies, we decided to explore the personal opinio n of a selected group of American (US and European (EU) experts by means of a simple questionnaire. A 13-item questionnaire was sent to 14 internation ally recognized opinion leaders in the field of haemodialysis: all seven Eu ropeans and five of the seven Americans responded. The answers to each ques tion were stratified in order to highlight the key differences between the experts in the different continents. Results. Ten of the 12 respondents (six EU and four US) said that dialysis outcomes are better in Europe; nine (six EU and three US) confirmed their o pinion after taking patient characteristics into account. When asked to sug gest reasons for this difference, the highest score was given to the qualit y of procedures and medical training with no differences between EU and US physicians. This was followed by three other factors that received the same overall score (financial issues, doctor bedside time and quality of pre-di alysis care), but it is interesting to note that the Europeans attributed c onsiderably greater importance to bedside time than their US counterparts. Conclusion. It seems that the reported difference in dialysis outcomes betw een Europe and the US is a widely accepted fact. Although directed towards few respondents, our questionnaire does suggest some differences in the app roach towards dialysis and endstage renal disease patients.