Introduction:
End-Stage Kidney Disease (ESKD) is the final, irreversible stage of Chronic Kidney Disease (CKD), where the patient needs renal replacement therapy, such as dialysis or a kidney transplant to survive. Dialysis encompasses two primary modalities: Hemodialysis (HD) and Continuous Ambulatory Peritoneal Dialysis (CAPD). While clinical factors and physician recommendations are important in determining the most appropriate treatment option, patient driven factors also play a crucial role. Our study tried to identify these factors, ranging from socioeconomic conditions to lifestyle considerations, that impact the patient's choice between HD and CAPD.
Methods:
This study was conducted over a one-year period at a tertiary care centre in Northeast India. The study included 327 patients with ESKD who were to be initiated on either HD or CAPD. After assessing the patient from the physician perspective, data was collected from patient using a structured interview and questionnaire, focusing on socioeconomic status, family and social support, proximity to dialysis centres, patient perceptions of treatment-related risks and challenges and any other factor which may influence the decision from the patient’s point of view.
Results:
Among the 327 patients, 63 (19.48%) chose CAPD, while 264 (80.52%) opted for HD. 72% of male patients opted for HD compared to 28% for CAPD. Conversely, women showed a more balanced distribution, with 55% choosing HD and 45% opting for CAPD. CAPD was more frequently selected those aged 65 and above, where 47.37% opted for CAPD compared to younger patients (p < 0.01). 66.29% of the HD group cited financial constraints as a critical factor (p < 0.05) and lower-income patients were significantly more likely to opt for HD. Among the patients who chose HD, 46.59% reported fear of CAPD-related infections as a decisive factor (p < 0.05). 29.55% patients mentioned the absence of home support as a barrier to choosing CAPD. Among the HD group, 76.14% lived within 20 kilometres of a dialysis centre, compared to only 19.05% of CAPD patients (p < 0.01). 68% of CAPD patients had strong family support and a conducive home environment, compared to 74% of HD patients who lacked such support and preferred professional care at a dialysis centre. Concerns about home hygiene and the burden on family members led 60% of the patients to avoid CAPD and opt for HD.
Conclusions:
The choice between HD and CAPD among ESKD patients is influenced by a multifaceted array of factors beyond clinical recommendations. Financial constraints, fear of complications, technical challenges, proximity to dialysis centres, social support, and personal preferences all play critical roles in this decision. This study highlights the importance of a patient-centred approach in the decision-making process and underscores the need for targeted interventions to support informed decision-making in this vulnerable population.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.