Patient Ratings of Dialysis Care With Peritoneal Dialysis vs Hemodialysis | Nephrology | JAMA | JAMA Network
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United States Renal Data System.  USRDS 2002 Annual Data Report. Bethesda, Md: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health; 2002.
Collins AJ, Hao W, Xia H.  et al.  Mortality risks of peritoneal dialysis and hemodialysis.  Am J Kidney Dis.1999;34:1065-1074. Scholar
Heaf JG, Lokkegaard H, Madsen M. Initial survival advantage of peritoneal dialysis relative to hemodialysis.  Nephrol Dial Transplant.2002;17:112-117. Scholar
Murphy SW, Foley RN, Barrett BJ.  et al.  Comparative mortality of hemodialysis and peritoneal dialysis in Canada.  Kidney Int.2000;57:1720-1726. Scholar
King K. Patients' perspective of factors affecting modality selection: a National Kidney Foundation patient survey.  Adv Ren Replace Ther.2000;7:261-268. Scholar
Rubin HR, Jenckes M, Fink NE.  et al. for Choices for Healthy Outcomes in Caring for ESRD.  Patient's view of dialysis care: development of a taxonomy and rating of importance of different aspects of care: CHOICE study.  Am J Kidney Dis.1997;30:793-801. Scholar
Wuerth DB, Finkelstein SH, Kliger AS, Finkelstein FO. Patient assessment of quality of care in a chronic peritoneal dialysis facility.  Am J Kidney Dis.2000;35:638-643. Scholar
Mendelssohn DC, Mullaney SR, Jung B, Blake PG, Mehta RL. What do American nephologists think about dialysis modality selection?  Am J Kidney Dis.2001;37:22-29. Scholar
Powe NR, Klag MJ, Sadler JH.  et al.  Choices for Healthy Outcomes in Caring for End Stage Renal Disease.  Semin Dial.1996;9:9-11.Google Scholar
Wu AW, Fink NE, Cagney KA.  et al.  Developing a health-related quality-of-life measure for end-stage renal disease: the CHOICE Health Experience Questionnaire.  Am J Kidney Dis.2001;37:11-21. Scholar
Athienites NV, Miskulin DC, Fernandez G.  et al.  Comorbidity assessment in hemodialysis and peritoneal dialysis using the Index of Coexistent Disease.  Semin Dial.2000;13:320-326. Scholar
Ware Jr JE, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36), I: conceptual framework and item selection.  Med Care.1992;30:473-483. Scholar
McHorney CA, Ware JE, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36), II: psychometric and clinical tests of validity in measuring physical and mental health constructs.  Med Care.1993;31:247-263. Scholar
Zeger SL, Liang KY, Albert PS. Models for longitudinal data: a generalized estimating equation approach.  Biometrics.1988;44:1049-1060. Scholar
Golper T. Patient education: can it maximize the success of therapy?  Nephrol Dial Transplant.2001;16(suppl 7):20-24. Scholar
Valderrabano F, Golper T, Muirhead N, Ritz E, Levin A. Chronic kidney disease: why is management so uncoordinated and suboptimal?  Nephrol Dial Transplant.2001;16(suppl 7):61-64. Scholar
Zimmerman DL, Selick A, Singh R, Mendelssohn DC. Attitudes of Canadian nephrologists, family physicians, and patients with kidney failure toward primary care delivery for chronic dialysis patients.  Nephrol Dial Transplant.2003;18:305-309. Scholar
Steinman TI. Managed care, capitation, and the future of nephrology.  J Am Soc Nephrol.1997;8:1618-1623. Scholar
Cooper BS, Eggers PW, Edington BM. Development of an end-stage renal disease managed care demonstration.  Adv Ren Replace Ther.1997;4:332-339. Scholar
Eggers PW, Frankenfield DL, Greer JW, McClellan W, Owen Jr WF, Rocco MV. Comparison of mortality and intermediate outcomes between Medicare dialysis patients in HMO and fee for service.  Am J Kidney Dis.2002;39:796-804. Scholar
Hirth RA, Held PJ. Some of the small print on managed care proposals for end-stage renal disease.  Adv Ren Replace Ther.1997;4:314-324. Scholar
Nelson EC, Rubin HR, Hays RD, Meterko M. Patient judgments of hospital quality: response to questionnaire.  Med Care.1990;28:S18-S22. Scholar
Murray BP, Dwore RB, Gustafson G, Parsons RJ, Vorderer LH. Enrollee satisfaction with HMOs and its relationship with disenrollment.  Manag Care Interface.2000;13:55-61. Scholar
Rubin HR, Gandek B, Rogers WH, Kosinski M, McHorney CA, Ware Jr JE. Patients' ratings of outpatient visits in different practice settings: results from the Medical Outcomes Study.  JAMA.1993;270:835-840. Scholar
Medicare Payment Advisory Commission.  Endstage renal disease policies in traditional Medicare. In: Report to Congress: Medicare Payment Policy. Washington, DC: Medicare Payment Advisory Commission; March 2001:128.
 Center for Medicare and Medicaid Services Medicare Program Revisions to Payment Policies under the Physician Fee Schedule for Calendar Year 2004. Available at: Accessibility verified January 7, 2004.
Original Contribution
February 11, 2004

Patient Ratings of Dialysis Care With Peritoneal Dialysis vs Hemodialysis

Author Affiliations

Author Affiliations: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Md (Drs Rubin and Powe and Mss Fink and Plantinga); Department of Health Policy and Management (Drs Rubin and Powe) and Department of Epidemiology (Drs Rubin and Powe and Ms Fink), The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md; Independent Dialysis Foundation, Baltimore, Md (Dr Sadler); and Department of Medicine, Hospital of St Raphael and Department of Medicine, Yale University, New Haven, Conn (Dr Kliger).

JAMA. 2004;291(6):697-703. doi:10.1001/jama.291.6.697

Context In light of conflicting evidence of differential effects of dialysis modality on survival, patient experience becomes a more important consideration in choosing between hemodialysis and peritoneal dialysis.

Objective To compare patient satisfaction with hemodialysis and peritoneal dialysis in a cohort of patients who have recently begun dialysis.

Design and Setting Cross-sectional survey at enrollment in a prospective inception cohort study of patients who recently started dialysis at 37 dialysis centers participating in the Choices for Healthy Outcomes in Caring for End-stage Renal Disease (CHOICE) study, a national multicenter study of dialysis outcomes, from October 1995 to June 1998.

Patients Of 736 enrolled incident dialysis patients, 656 (89%) returned a satisfaction questionnaire after an average of 7 weeks of dialysis.

Main Outcome Measure Data collected from a patient-administered questionnaire including 3 overall ratings and 20 items rating specific aspects of dialysis care.

Results Patients receiving peritoneal dialysis were much more likely than those receiving hemodialysis to give excellent ratings of dialysis care overall (85% vs 56%, respectively; relative probability, 1.46 [95% confidence interval, 1.31-1.57]) and significantly more likely to give excellent ratings for each specific aspect of care rated. The 3 items with the greatest differences were in the domain of information provided (average of information items: peritoneal dialysis [69% excellent] vs hemodialysis [30% excellent]). The smallest differences were in ratings of accuracy of information from the nephrologist, response to pain, amount of fluid removed, and staff availability in an emergency. Adjustment for patient age, race, education, health status, marital status, employment status, distance from the center, and time since starting dialysis did not reduce the differences between peritoneal dialysis and hemodialysis patients.

Conclusions After several weeks of initiating dialysis, patients receiving peritoneal dialysis rated their care higher than those receiving hemodialysis. These findings indicate that clinicians should give patients more information about the option of peritoneal dialysis.