What do American nephrologists think about dialysis modality selection?

In the United States, 87.3% of the patients with end-stage renal disease (E SRD) requiring dialysis are treated with hemodialysis (HD) and 12.7% with p eritoneal dialysis (PD). This represents a greater use of HD than in many o ther nations. We mailed a survey questionnaire to members of the National K idney Foundation Council on Dialysis to better understand the attitudes of American nephrologists toward dialysis modality decisions. We received resp onses from 240 of 507 nephrologists (47.3%), The respondents were heavily i nvolved in clinical dialysis work. Results showed that decisions regarding modality selection were strongly based on patient preference (4.54 on a sca le of 1 to 5), quality of life (4.18), morbidity (4.02), and mortality (3.9 0), whereas the least important factors reported were facility reimbursemen t (2.09) and physician reimbursement (1.98). When asked about the current u se of modalities, hospital-based HD and full-care HD were believed to be ov erused (2.63 for each on a scale of 1 [vastly overused] to 5 [vastly underu sed]), whereas home HD (4.29), continuous ambulatory PD (3.71), and cycler PD (3.59) were underused. A hypothetical question about optimal modality di stribution to maximize survival or cost-effectiveness showed that HD should constitute 71% or 66% of dialysis (with 11% or 14% in the form of home HD, respectively). PD use would increase between two- and threefold over curre nt practices. Our results suggest that American nephrologists believe home therapies are underused. Because modality distribution is an important dete rminant of costs and possibly outcomes in patients with ESRD, there is an u rgent need for further research in this area. (C) 2001 by the National Kidn ey Foundation, Inc.