This qualitative analysis using electronic medical records from the Department of Veterans Affairs examines the factors influencing the timing of initiation of dialysis in clinical practice.
Few US patients with kidney failure start treatment on peritoneal dialysis (PD) despite its potential survival, quality of life, and cost-saving benefits. We investigated patient awareness of PD and variables associated with PD selection, including dialysis unit ownership and geographic area.
In a cohort study, incident dialysis patients identified by the Centers for Medicare and Medicaid Services (CMS) and included in the United States Renal Data System (USRDS) were surveyed from 2005 to 2007 for the USRDS Comprehensive Dialysis Study. Participants reported whether PD had been discussed with them before they started regular treatment for kidney failure, and initial dialysis modality was verified in the USRDS patient registry.
The proportion of patients in our study cohort who reported that PD had been discussed with them (61%) was higher than in previous surveys, but only 10.9% of informed patients initiated PD. With patient demographic and clinical characteristics controlled for, the proportion of informed patients who started PD differed substantially across large dialysis organizations. Substantial variation in selection of PD was also evident among patients starting dialysis in the 18 end-stage renal disease Network areas.
Despite patients' early awareness of PD as a treatment option, PD selection was low in this national cohort. Factors associated with PD selection merit continued study as CMS seeks to improve quality and cost-effectiveness of kidney patient care.
Hsu et al assess the effectiveness and safety of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers as therapy for advanced chronic kidney disease in patients with hypertension and anemia who are not undergoing dialysis. See the Invited Commentary by Park and Hsu.
Winkelmayer et al determine the trends in anemia treatment received by Medicare beneficiaries approaching end-stage renal disease. Coyne provides an Invited Commentary.
This study describes the characteristics, angiographic findings, and treatment patterns of patients with stable angina symptoms undergoing cardiac catheterization and/or percutaneous coronary intervention before noncardiac surgery in a large national registry.