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Kidney Week

Abstract: TH-PO316

Factors Associated with Discordance in Initial ESKD Treatment Decision and Eventual Dialysis Modality

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Author

  • Liew, Adrian, Tan Tock Seng Hospital, Singapore, Singapore
Background

Pre-Dialysis counselling (DC) prepares patients with ESKD for renal replacement therapy (RRT). However, the eventual RRT modality may differ from the initial decision made at DC, making a prepared start on dialysis challenging. We study the distribution of treatment decisions made after DC and factors associated with a change in the eventual RRT modality at initiation.

Methods

This prospective cohort study included patients who underwent DC from APR 2010 to DEC 2015, and followed till 30 APR 2019 for their eventual RRT modality. All data were collected prospectively, with the study population grouped according to the initial treatment decision and stratified by eventual RRT modality (Table 1). Multivariate logistic regression was performed, examining factors that influence discordance in treatment decision and eventual modality. Variables were included in the model if univariate analysis has p-value<0.20.

Results

1644 patients (63.3±13.1 years, 57% males, 77% DM) were included in the study, after excluding 47 without any decision and 42 who had not initiated RRT. HD (65.6%) was the most common choice of RRT after DC, while patients who chose PD were less likely to be actualized on their chosen therapy (PD 50.4%, HD 96.9%; p<0.001). Patients who chose PD were also more likely to die before needing RRT (PD 12.3%, HD 3.0%; p<0.001). Multivariate analysis showed that failure to actualize the decision for PD was associated with factors that suggested greater frailty or potential challenges to PD (Table 2).

Conclusion

Patients who chose PD were less likely to receive this RRT modality. These patients were older and frail, with a high proportion who died before requiring RRT. Difficulties with PD such as obesity, poor diabetic control and lack of home storage space for PD solutions may also influence a subsequent switch to HD.