Factors involved in choice of dialysis treatment modality: a study in ninedialysis centers

Background: the objective of this cross-sectional study in a population of 1472 dialysis patients was to identify the main factors involved in the cho ice of a specific option for dialysis therapy, taking into account three di fferent types of criteria such as medical dependence (DM), nurse care requi rement (SI) and independence for dialysis therapy (CA). Methods: each patient has been analysed, independently of present treatment modality according to the above three criteria, namely DM, SI and CA. For each type of parameter, patients have been allocated to one of three levels , each level being established to evaluate whether dialytic treatment shoul d be undertaken as hospital centre dialysis (HDC) or in a facility off the hospital. Level 3 of any one category corresponded to the inability of doin g hae- modialysis at home (HHD) or in self-care unit (AD). Level 2 included patients who could be treated in AD or by peritoneal dialysis (PD) with th e assistance of a nurse. CAPD or HHD were considered as potential treatment modalities only in patients qualifying for level 1 of each criterion. Results: in the patient population as a whole, the following treatment opti ons were observed. HHD 3.6 %, CAPD 6 %, PD 1.8 %, AD 16.3 % and HDC 72.2 %. For medical dependence (DM) there was a relatively even distribution for t he three levels in six centres. In contrast, two centres were characterized by a predominance of DM level 3. Differences in DM levels between centres were greatly reduced when considering separately only those patients who we re actually treated by CAPD, HDC and AD. SI levels were more uniformly dist ributed within all centres, and this was true for HCD and AD patients. When considering CA levels in HDC patients, a large predominance of CA level 3 was observed in all centres whereas CA level 1 was nearly inexistent. Concl usion :the major finding of this study was that the inability or the refusa l of dialysis patients to participate at treatment, independently of medica l condition and nurse care requirement, was the main factor in the choice o f hospital centre dialysis.