LAUSR

Effective outpatient organization is essential in the management of patients with chronic kidney disease. Although peritoneal dialysis (PD) has many advantages it is still not popular. The aim of this study was to evaluate patient and center-related factors that affect the final choice of peritoneal dialysis (PD) versus hemodialysis (HD) in the Calabrian region (Italy). We analyzed 2 annual regional surveys performed by nephrologists (2017 and 2018) in incident dialysis patients. Collected factors included: early and late referral to the dialysis program, pre-dialysis participation in outpatient visits, first dialysis access [peritoneal catheter (PC), central venous catheter (CVC), arteriovenous fistula (AVF)], final dialysis treatment (HD or PD) and the care giver. The study sample included 296 incident patients (63% males) aged 66±15 years. Time to referral influenced the type of first dialysis access. Among patients with early referral, 35% initiated dialysis by a PC, 34% by AVF and 31% by CVC, while among those with late referral, only 5% started dialysis by a PC, 15% by AVF, and the majority (80%) by CVC (P<0.001). Time to referral was also associated with pre-dialysis visits (34%, 33% and 34% versus 5%, 22% and 73%, respectively, P<0.001). When evaluating clinical suitability for treatment modality, 54% of early referrals and 45% of late referrals were eligible for PD. The choice of dialytic modality was again related to time to referral: 38% with early referral chose PD compared to 15% of those with late referral (P<0.001). Furthermore, in patients who participated in the pre-dialysis program, 38% started PD versus 11% of patients that did not participate (P<0.001). The role of the caregiver remains uncertain. These data confirm that a more attentive and dedicated organization of the pre-dialysis outpatient program would contribute to a greater expansion of the peritoneal dialysis program.