TY - JOUR

T1 - What are the factors that determine treatment choices in patients with kidney failure: a retrospective cohort study using data linkage of routinely collected data in Wales

AU - Chess, James

AU - Roberts, Gareth

AU - McLaughlin, Leah

AU - Williams, Gail

AU - Noyes, Jane

N1 - © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2024/2/13

Y1 - 2024/2/13

N2 - Objectives To identify the factors that determine treatment choices following pre-dialysis education.Design Retrospective cohort study using data linkage with univariate and multivariate analyses using linked data.Setting Secondary care National Health Service Wales healthcare system.Participants All people in Wales over 18 years diagnosed with established kidney disease, who received pre-dialysis education between 1 January 2016 and 12 December 2018.Main outcome measures Patient choice of dialysis modality and any kidney replacement therapy started.Results Mean age was 67 years; n=1207 (60%) were male, n=878 (53%) had ≥3 comorbidities, n=805 (66%) had mobility problems, n=700 (57%) had pain symptoms, n=641 (52%) had anxiety or were depressed, n=1052 (61.6%) lived less than 30 min from their treatment centre, n=619 (50%) were on a spectrum of frail to extremely vulnerable. n=424 (25%) chose home dialysis, n=552 (32%) chose hospital-based dialysis, n=109 (6%) chose transplantation, n=231 (14%) chose maximum conservative management and n=391 (23%) were ‘undecided’. Main reasons for not choosing home dialysis were lack of motivation/low confidence in capacity to self-administer treatment, lack of home support and unsuitable housing. Patients who choose home dialysis were younger, had lower comorbidities, lower frailty and higher quality of life scores. Multivariate analysis found that age and frailty were predictors of choice, but we did not find any other demographic associations. Of patients who initially chose home dialysis, only n=150 (54%) started on home dialysis.Conclusion There is room for improvement in current pre-dialysis treatment pathways. Many patients remain undecided about dialysis choice, and others who may have chosen home dialysis are still likely to start on unit haemodialysis.

AB - Objectives To identify the factors that determine treatment choices following pre-dialysis education.Design Retrospective cohort study using data linkage with univariate and multivariate analyses using linked data.Setting Secondary care National Health Service Wales healthcare system.Participants All people in Wales over 18 years diagnosed with established kidney disease, who received pre-dialysis education between 1 January 2016 and 12 December 2018.Main outcome measures Patient choice of dialysis modality and any kidney replacement therapy started.Results Mean age was 67 years; n=1207 (60%) were male, n=878 (53%) had ≥3 comorbidities, n=805 (66%) had mobility problems, n=700 (57%) had pain symptoms, n=641 (52%) had anxiety or were depressed, n=1052 (61.6%) lived less than 30 min from their treatment centre, n=619 (50%) were on a spectrum of frail to extremely vulnerable. n=424 (25%) chose home dialysis, n=552 (32%) chose hospital-based dialysis, n=109 (6%) chose transplantation, n=231 (14%) chose maximum conservative management and n=391 (23%) were ‘undecided’. Main reasons for not choosing home dialysis were lack of motivation/low confidence in capacity to self-administer treatment, lack of home support and unsuitable housing. Patients who choose home dialysis were younger, had lower comorbidities, lower frailty and higher quality of life scores. Multivariate analysis found that age and frailty were predictors of choice, but we did not find any other demographic associations. Of patients who initially chose home dialysis, only n=150 (54%) started on home dialysis.Conclusion There is room for improvement in current pre-dialysis treatment pathways. Many patients remain undecided about dialysis choice, and others who may have chosen home dialysis are still likely to start on unit haemodialysis.

KW - Aged

KW - Female

KW - Frailty

KW - Humans

KW - Information Storage and Retrieval

KW - Kidney Failure, Chronic/therapy

KW - Male

KW - Quality of Life

KW - Renal Dialysis

KW - Renal Insufficiency

KW - Retrospective Studies

KW - Routinely Collected Health Data

KW - State Medicine

KW - Wales

U2 - 10.1136/bmjopen-2023-082386

DO - 10.1136/bmjopen-2023-082386

M3 - Article

C2 - 38355196

VL - 14

SP - e082386

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 2

M1 - e082386

ER -