Predicting a patient's choice of dialysis modality: Experience in a UnitedKingdom renal department

Education and counseling are important aspects of the management of patient s starting dialysis. Free choice of modality may enhance patient well-being and, in the absence of clear survival benefits for either hemodialysis (HD ) or continuous ambulatory peritoneal dialysis (CAPD), should have the majo r role in modality selection. This prospective study examines factors influ encing this choice. Three hundred thirty-three new patients started renal r eplacement therapy at Birmingham Heartlands Hospital (Birmingham, UK) betwe en August 1, 1992, and July 31, 1998. Data were incomplete for 14 patients, 11 patients were not counseled, and 54 patients had contraindications to a particular modality. The remaining 254 patients were offered a free choice . One hundred thirty-nine patients (55%) chose HD and 115 patients (45%) ch ose CARD. Independent predictors for choosing CARD rather than HD were bein g married (P = 0.004), being counseled before the start of dialysis (P = 0. 019), and increased distance from the base unit (P < 0.001). Independent pr edictors for choosing HD were increasing age (P = 0.030) and male sex (P = 0.041). Use of these data should enhance planning of dialysis services and bring nearer the goal that all new patients with ESRD are able to have the dialysis modality of their choice. (C) 2001 by the National Kidney Foundati on, Inc.