Dr SASKIA LEIBOWITZ1, Dr N SHAH2, J BAHRANI3, G ABRA4, PN BENNETT5, T KANJANABUCH6, Dr YEOUNGJEE CHO1
1Princess Alexandra Hospital, Woolloongabba, Australia, 2University of Alberta, Edmonton, Canada, 3University Hospitals Birmingham, , United Kingdom, 4Satellite Healthcare and Department of Medicine, Division of Nephrology, Stanford University School of Medicine, , USA, 5University of South Australia, Adelaide, Australia, 6Chulalongkorn University, Bangkok, Thailand
Aim:
To determine factors influencing decisions to select peritoneal dialysis (PD) in various clinical scenarios.
Background:
PD is an underutilised modality despite few contraindications. Physician attitude towards PD may be an important contributor influencing the decision.
Methods:
A global online survey was administered to nephrologists and trainees. Ethics approval was granted by the University of Alberta, Canada. Participants provided informed consent and data were analysed descriptively using the statistical software Stata.
Results:
The survey was completed by 645 participants (80.9% nephrologists and 19.1% trainees) from 54 countries, with 65.6% of respondents from high-income countries.
PD was recommended for patients desiring pregnancy; weightlifters; in polycystic kidney disease; in cirrhotic patients; in chronically immunosuppressed patients; and for urgent dialysis.
Respondents were more likely to offer PD to patients with pets if they had separate rooms. However, respondents from low-income countries were more likely to offer PD (75%) without a separate room compared with high-income country respondents (48.6%).
Most participants indicated they would not offer PD following laparotomy or hemicolectomy. However, nephrologists and respondents from PD units offering ambulatory services were more likely to offer PD in these cases. Respondents from larger units were more likely to offer PD following radiotherapy for ovarian cancer.
The provision of PD to obese patients was associated with income-status of the country, with 75% of respondents from low-income countries not offering PD compared with 21.5% of respondents from high-income countries.
Conclusions:
Physician attitudes towards the provision of PD across certain clinical scenarios may be shaped by clinical experience, with differences in responses observed according to income, profession, the size of PD units and experience working in ambulatory PD units.
Biography:
Dr Saskia Leibowitz is a first-year Nephrology advanced trainee at the Princess Alexandra Hospital. She completed her residency in Townsville, where she had ongoing involvement with Indigenous patients and observed the unique cultural, social and geographic challenges which hamper both their access to treatment and their recovery. She aspires to improve access to healthcare by Indigenous patients, a population vulnerable to kidney disease, and to devise means of providing high-level care to these patients in their remote locations, in order to improve health outcomes, thereby improving quality of life.