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.
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.
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.
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
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.