To the Editor: Dr Rubin and colleagues1 reported that patients receiving peritoneal dialysis rated their care higher than did patients receiving hemodialysis. We are concerned that the authors did not account for several factors related to the choice of peritoneal dialysis vs hemodialysis.
First, patients receiving peritoneal dialysis in this study were more likely to be white and to have graduated from high school; thus, they were also more likely to be employed and to have health insurance. This is important because white patients were more likely to rate their care better, as were patients with fewer comorbidities.
Second, it is not clear how patients selected one type of dialysis over the other. Approximately 50% of patients would choose peritoneal dialysis if this option were adequately explained,2 - 3 but as many as 20% would in fact not be good candidates for it.3 - 4 Also, there is a gradual rate of conversion from peritoneal dialysis to hemodialysis, but generally not the other way. This bias is difficult to control for using statistical methods. Patients who have experienced such treatment failures may be dissatisfied for other reasons. Furthermore, patients just beginning dialysis may have different experiences early in their treatment because patients in the early days of their peritoneal dialysis receive more intense education. Thus, the authors should have limited their analysis to patients who had already been stabilized on their respective procedures.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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