Patient Preferences and Information Gaps Underlying the Predominance of Hemodialysis in Türkiye: A Cross-Sectional Survey of 1908 Patients.

Abstract

Introduction: Chronic kidney disease (CKD) is an important public health problem that is increasingly prevalent in Türkiye and the world. Patients with CKD should be informed about renal replacement therapy (RRT) before progression to end-stage kidney disease, and the most appropriate therapy should be selected for each patient. Although three different renal replacement therapy modalities exists, hemodialysis appears to be the most commonly chosen. In this study, we aimed to investigate why hemodialysis is often selected as the first-line therapy by patients.  Methods. In this cross-sectional, survey study; patients aged 18-80, who had been receiving treatment for more than three months and had initiated hemodialysis as their first RRT between 2010 and 2020 in Kahramanmaras, Kocaeli, and Istanbul were included. Patients completed a self-administered multiple-choice questionnarire.

Results: A total of 1908 patients were included in the study. Before initiating hemodialysis, 61.1% of patients were under nephrology follow-up, whereas 38.3% had no prior follow-up. Alternative therapies to hemodialysis (peritoneal dialysis and kidney transplantation) were explained to 720 patients (37.7%), but not to 1,159 patients (60.7%). A total of 635 patients (33.3%) were asked about their treatment preferences, while 66% were not. After hemodialysis initiation, 937 patients (49.1%) were listed for cadaveric kidney transplantation, wheras 49.5% were not.

Conclusion: Our study is a large, cross-sectional investigation of 1908 patients who selected hemodialysis as their initial RRT. The reasons patients choose hemodialysis over other modalities have long been debated, and substantial knowledge gaps among patients have been identified. We believe that nephrologist follow-up and patient information are important in choosing renal replacement therapy.