US nephrologists' recommendation of dialysis modality: Results of a national survey

Selection of a dialysis modality for persons with end-stage renal disease ( ESRD) has important lifestyle and occupational implications. The factors af fecting modality choice remain unclear, resulting in a low rate of peritone al dialysis (PD) in the United States compared with other countries. A nati onal survey of 271 US nephrologists was conducted from June 1997 to June 19 98 to assess the relative importance of nonclinical and clinical factors re lated to dialysis modality selection for patients with ESRD. Hypothetical p atient scenarios were randomly assigned to nephrologists to determine their recommendation for dialytic therapy based on patient demographic, clinical , and social factors. US nephrologists were more likely to recommend PD for men with ESRD compared with women (39% versus 33%; P < 0.05; adjusted odds ratio, 1.44; 95% confidence interval, 1.15 to 1.80), as well as for patien ts with good compliance (adjusted odds ratio, 11.80; 95% confidence interva l, 9.29 to 15.01), weight less than 200 lb (adjusted odds ratio, 2.3; 95% c onfidence interval, 1.8 to 2.9), residual renal function (adjusted odds rat io, 2.14; 95% confidence interval, 1.71 to 2.70), absence of diabetes (adju sted odds ratio, 2.0; 95% confidence interval, 1.6 to 2.5), and living with family (adjusted odds ratio, 1.7; 95% confidence interval, 1.4 to 2.1). Ne phrologists in practice for 11 or more years were less likely to recommend PD. The association of male sex with PD therapy suggests a potential bias o r sensitivity to women's perception of body image. Race was not associated with PD recommendations after controlling for other demographic and clinica l characteristics. Because the incident US ESRD population is increasingly characterized by factors associated with not selecting PD (diabetes, obesit y, malnourishment, living alone, and substance abuse problems), our results suggest that PD use may decrease over time. (C) 2000 by the National Kidne y Foundation, Inc.