US adoption of peritoneal dialysis limited by clinician “misconceptions”, study suggests

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The use of peritoneal dialysis (PD) in treating chronic kidney disease (CKD) patients is limited in the USA by the mistaken assumptions of clinicians, in part a result of insufficient education by healthcare providers, claims a new study published in the Cureus Journal of Medical Science.

Despite an “encouraging” programme from the US government aimed at improving public understanding of end-stage kidney disease (ESKD), the study authors say that “misconceptions and differing attitudes about PD among physicians” remain “important barriers” to its further implementation.

The study, led by Hussain S Lalani (Brigham and Women’s Hospital, Boston, USA), employed a ten-question survey “to assess the knowledge and attitudes around peritoneal dialysis and haemodialysis among internal medicine faculty at the University of Texas Southwestern Medical Center” in Dallas, USA. Lalani et al stress that, despite the “well-established benefits of PD”, including a “lower adjusted mortality rate” and better transplant outcomes, not to mention its considerably lower cost compared to in-centre haemodialysis, it was still unclear why “more patients [are] not receiving PD”.

Lalani et al distributed their survey to both nephrologists and non-nephrologists, with 83 recipients fully completing it. Of those, 10 were nephrologists and the remaining 73 were from other disciplines. Both groups reported “increased perceived knowledge and comfort with caring for patients on HD compared to patients on PD”. Nephrologists “scored 30% correct responses regarding medical contraindications and 48% regarding psychosocial contraindications to PD”. The authors describe it as “interesting”, meanwhile, that “non-nephrologists scored higher regarding medical contraindications” even though they reported “lower comfort and perceived knowledge (42.5% and 20.5%) of PD”.

In their discussion, the authors state that the results suggest there is a “knowledge gap” between haemodialysis and PD among both nephrologists and non-nephrologists. They note that nephrologists were more likely to “overperceive” medical contraindications for PD than non-nephrologists, and that it suggests a “disproportionate hesitancy” towards PD among nephrologists. They are quick to stipulate that their study had its limitations, however, including its small sample size. The subject required further study on a larger scale, they argue.

The authors are firm in their concluding emphasis on “the importance of basic education regarding PD candidacy and the subversion of misconceptions regarding PD among clinicians,” including both nephrologists and non-nephrologists. They suggest a long-term solution to the issues the study raised in the form of regional centres of excellence dedicated to training physicians and other health professionals on PD.

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