An assessment of dialysis provider¿s attitudes towards timing of dialysis initiation in Canada

Mann, Bikaramjit S; Manns, Braden J; Dart, Allison; Kappel, Joanne; Molzahn, Anita; Naimark, David; Nessim, Sharon J; Soroka, Steven; Zappitelli, Michael; Sood, Manish M; on behalf of the Canadian Kidney Knowledge Translation and Generation Network (CANN-NET)

An assessment of dialysis provider¿s attitudes towards timing of dialysis initiation in Canada

dc.contributor.author	Mann, Bikaramjit S
dc.contributor.author	Manns, Braden J
dc.contributor.author	Dart, Allison
dc.contributor.author	Kappel, Joanne
dc.contributor.author	Molzahn, Anita
dc.contributor.author	Naimark, David
dc.contributor.author	Nessim, Sharon J
dc.contributor.author	Soroka, Steven
dc.contributor.author	Zappitelli, Michael
dc.contributor.author	Sood, Manish M
dc.contributor.author	on behalf of the Canadian Kidney Knowledge Translation and Generation Network (CANN-NET)
dc.date.accessioned	2014-04-07T19:09:52Z
dc.date.available	2014-04-07T19:09:52Z
dc.date.issued	2014-04-07
dc.date.updated	2014-04-07T19:09:53Z
dc.description.abstract	Abstract Background Physicians’ perceptions and opinions may influence when to initiate dialysis. Objective To examine providers’ perspectives and opinions regarding the timing of dialysis initiation. Design Online survey. Setting Community and academic dialysis practices in Canada. Participants A nationally-representative sample of dialysis providers. Measurements and Methods Dialysis providers opinions assessing reasons to initiate dialysis at low or high eGFR. Responses were obtained using a 9-point Likert scale. Early dialysis was defined as initiation of dialysis in an individual with an eGFR greater than or equal to 10.5 ml/min/m2. A detailed survey was emailed to all members of the Canadian Society of Nephrology (CSN) in February 2013. The survey was designed and pre-tested to evaluate duration and ease of administration. Results One hundred and forty one (25% response rate) physicians participated in the survey. The majority were from urban, academic centres and practiced in regionally administered renal programs. Very few respondents had a formal policy regarding the timing of dialysis initiation or formally reviewed new dialysis starts (N = 4, 3.1%). The majority of respondents were either neutral or disagreed that late compared to early dialysis initiation improved outcomes (85-88%), had a negative impact on quality of life (89%), worsened AVF or PD use (84-90%), led to sicker patients (83%) or was cost effective (61%). Fifty-seven percent of respondents felt uremic symptoms occurred earlier in patients with advancing age or co-morbid illness. Half (51.8%) of the respondents felt there was an absolute eGFR at which they would initiate dialysis in an asymptomatic patient. The majority of respondents would initiate dialysis for classic indications for dialysis, such as volume overload (90.1%) and cachexia (83.7%) however a significant number chose other factors that may lead them to early dialysis initiation including avoiding an emergency (28.4%), patient preference (21.3%) and non-compliance (8.5%). Limitations 25% response rate. Conclusions Although the majority of nephrologists in Canada who responded followed evidence-based practice regarding the timing of dialysis initiation, knowledge gaps and areas of clinical uncertainty exist. The implementation and evaluation of formal policies and knowledge translation activities may limit potentially unnecessary early dialysis initiation.
dc.description.version	Peer Reviewed
dc.identifier.citation	Canadian Journal of Kidney Health and Disease. 2014 Apr 07;1(1):3
dc.identifier.doi	http://dx.doi.org/10.1186/2054-3581-1-3
dc.identifier.uri	http://hdl.handle.net/1993/23414
dc.language.rfc3066	en
dc.rights	open access	en_US
dc.rights.holder	Bikaramjit S Mann et al.; licensee BioMed Central Ltd.
dc.title	An assessment of dialysis provider¿s attitudes towards timing of dialysis initiation in Canada
dc.type	Journal Article