An update on absolute and relative indications for dialysis treatment modalities

Lambie, Mark; Davies, Simon

Abstract

Background Choosing a dialysis modality is an important decision for people to make as their kidney failure progresses. In doing so, their options should be informed by any absolute or relative indications that may favour one modality over another. Methods In creating this update, we reviewed literature using a framework that considered first, high-level outcomes (survival and modality transition) from large registry data and cohort studies when considering optimal patient pathways; second, factors at a dialysis provider level that might affect relative indications; and third, specific patient-level factors. Both main types of dialysis modality, peritoneal (PD) and haemodialysis (HD), and their subtypes were considered. Results For most people starting dialysis, survival is independent of modality, including those with diabetes. Better survival is seen in those with less comorbidity starting with PD or home HD, reflecting continued improvements over recent decades that have been greater than improvements seen for centre HD. There are provider-level differences in the perceived relative indications for home dialysis that appear to reflect variability in experience, prejudice, enthusiasm, and support for patients and carers. Absolute contraindications are uncommon and, in most cases, where modality prejudice exists, e.g. obesity, Adult Polycystic Kidney Disease, and social factors, this is not supported by reported outcomes. Conclusion Absolute contraindications to a particular dialysis modality are rare. Relative indications for or against particular modalities should be considered but are rarely more important than patient preferences.

• Journal Article Type: Article
• Acceptance Date: Oct 31, 2022
• Online Publication Date: Sep 13, 2023
• Publication Date: Sep 13, 2023
• Deposit Date: Sep 25, 2023
• Publicly Available Date: Sep 25, 2023
• Journal: Clinical Kidney Journal
• Print ISSN: 2048-8505
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 16
• Issue: Supplement_1
• Pages: i39-i47
• DOI: https://doi.org/10.1093/ckj/sfad062
• Keywords: Transplantation, Nephrology