Research article
International practice patterns and factors associated with non-conventional hemodialysis utilization
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* Corresponding author: Manish M Sood Msood99@gmail.com
1 Department of Medicine, Section of Nephrology, St Boniface Hospital, University of Manitoba, 409 Tache Avenue, Winnipeg, R2H 2A6, Canada
2 Department of Medicine, Section of Nephrology, Abbotsford Regional Hospital, University of British Columbia, 32900 Marshall Road, Abbotsford, V3T 5H5, Canada
3 Department of Medicine, Section of Nephrology, University of Alberta, 112th Street, Edmonton, T6G 2G3, Canada
4 Department of Medicine, Section of Nephrology, The Ottawa Hospital, University of Ottawa. 1967 Riverside Drive, Ottawa, K1H 7W9, Canada
5 Department of Medicine, Section of Nephrology, Sunnybrook Hospital, University of Toronto, 2075 Bayview Avenue, Toronto, M4N 3M5, Canada
6 Department of Medicine, Section of Nephrology, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, M5G 2C4, Canada
7 Department of Medicine, Section of Nephrology, Seven Oaks Hospital, University of Manitoba, 2300 McPhillips Street, Winnipeg, R2V 3M3, Canada
BMC Nephrology 2011, 12:66 doi:10.1186/1471-2369-12-66
Published: 5 December 2011Abstract
Background
The purpose of our study was to determine characteristics that influence the utilization of non-conventional hemodialysis (NCHD) therapies and its subtypes (nocturnal (NHD), short daily (SDHD), long conventional (LCHD) and conventional hemodialysis (CHD) as well as provider attitudes regarding the evidence for NCHD use.
Methods
An international cohort of subscribers of a nephrology education website http://www.nephrologynow.com webcite was invited to participate in an online survey. Non-conventional hemodialysis was defined as any forms of hemodialysis delivered > 3 treatments per week and/or > 4 hours per session. NHD and SDHD included both home and in-centre. Respondents were categorized as CHD if their centre only offered conventional thrice weekly hemodialysis. Variables associated with NCHD and its subtypes were determined using multivariate logistic regression analysis. The survey assessed multiple domains regarding NCHD including reasons for initiating and discontinuing, for not offering and attitudes regarding evidence.
Results
544 surveys were completed leading to a 15.6% response rate. The final cohort was limited to 311 physicians. Dialysis modalities utilized among the respondents were as follows: NCHD194 (62.4%), NHD 83 (26.7%), SDHD 107 (34.4%), LCHD 81 (26%) and CHD 117 (37.6%). The geographic regions of participants were as follows: 11.9% Canada, 26.7% USA, 21.5% Europe, 6.1% Australia/New Zealand, 10% Africa/Middle East, 10.9% Asia and 12.9% South America. Variables associated with NCHD utilization included NCHD training (OR 2.47 CI 1.25-4.16), government physician reimbursement (OR 2.66, CI 1.11-6.40), practicing at an academic centre (OR 2.28 CI 1.25-4.16), higher national health care expenditure and number of ESRD patients per centre. Hemodialysis providers with patients on NCHD were significantly more likely to agree with the statements that NCHD improves quality of life, improves nutritional status, reduces EPO requirements and is cost effective. The most common reasons to initiate NCHD were driven by patient preference and the desire to improve volume control and global health outcomes.
Conclusion
Physician attitudes toward the evidence for NCHD differ significantly between NCHD providers and conventional HD providers. Interventions and health policy targeting these areas along with increased physician education and training in NCHD modalities may be effective in increasing its utilization.