International practice patterns and factors associated with non-conventional hemodialysis utilizationReport as inadecuate

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BMC Nephrology

, 12:66

First Online: 05 December 2011Received: 04 July 2011Accepted: 05 December 2011


BackgroundThe 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.

MethodsAn international cohort of subscribers of a nephrology education website 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.

Results544 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.

ConclusionPhysician 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.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2369-12-66 contains supplementary material, which is available to authorized users.

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Author: Nathan Allen - Daniel Schwartz - Paul Komenda - Robert P Pauly - Deborah Zimmerman - Gemini Tanna - Jeffery Schiff - Claud


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