ESRD patients do better when they are actively engaged in dialysis decisions

End-Stage Renal Disease (ESRD) can leave patients feeling powerless. Engagement and involvement in modality choice at least offers them the option to choose the type of dialysis that best fits their lifestyle and personality, as well as their clinical status. In a situation where compliance is critical, this would seem to be the best approach to dialysis therapy selection, and indeed, the research supports it.


The power of ESRD patient engagement is reflected in survival and transplantation rates

ESRD patients who take the lead in choosing their dialysis modality have significantly higher renal transplantation rates and significantly higher four-year survival rates. Patients who contributed the most to therapy selection also benefited the most.1

Satisfaction and compliance are also impacted

Survival and transplantation rates are higher among engaged patients regardless of modality chosen. However, when it comes to patient satisfaction, Peritoneal Dialysis (PD) patients are more satisfied with their care than Hemodialysis (HD) patients, and it appears that part of that difference may be the result of more information provided to PD patients. 69% of PD patients rated “excellent” the amount of information they received on choosing HD or PD, while only 26% of HD patients felt the same way.2


Patient compliance with their dialysis regime, defined by following their diet, fluid intake, medications and dialysis treatment times, continues to be a problem regardless of the dire consequences shared with the patient. More closely matching a patient’s personality with the modality’s characteristics may help reduce non-compliance.  


In an article by Alan Christensen, he attempts to determine causes for patient non-compliance, identifying which factors will most affect a patient’s ability or drive to follow their prescribed treatment. He states that compliance is linked to matching a patient’s preferred style of coping with the experience offered by the treatment. In other words, matching a patient’s desire for involvement and control with the amount of involvement and control permitted by the dialysis modality will increase compliance.3 This means that a patient with a strong desire for control may do better on a more self-directed home therapy.

ESRD patients might not know they have a choice

Until the need for dialysis occurs, patients are unlikely to have thought about the options. And during any kind of health issue, it can be tough for even the savviest of patients to ask the right questions.

One study showed that 35% of patients with stage three-to-five Chronic Kidney Disease “had no knowledge of any therapeutic modality for ESRD.”4

Baxter can help. We have created materials that can help providers identify PD candidates, as well as materials that prospective PD patients can take home to read. More information, links and downloads are located in the Talking to Patients section.
Stack, Austin G, Martin, David R, et al. Association of Patient Autonomy with Increased Transplantation and Survival Among New Dialysis Patients in the United States. Am J Kidney Dis. 2005;45: 730-742.
2 Rubin, Haya R, Fink, Nancy E, et al. Patient ratings of Dialysis Care With Peritoneal Dialysis vs Hemodialysis. JAMA. 2004;291: 697-703.
3 Christensen A. Patient-by-Treatment Context Interaction in Chronic Disease: A Conceptual Framework for the Study of Patient Adherence. Psychosomatic Medicine. 2000;62:435–443.
4 Finkelstein, Fredric O, Story, Kenneth, et al. Perceived Knowledge Among Patients Cared for by Nephrologists About Chronic Kidney Disease and End-Stage Renal Disease Therapies. Kidney International. 2008;74:1178-1184.

Patients who contributed the most to therapy selection also benefited the most.1