Dialysis modality preference of patients with CKD and family caregivers: a discrete-choice study

Morton, Rachael L., Snelling, Paul, Webster, Angela C., Rose, John, Masterson, Rosemary, Johnson, David W. and Howard, Kirsten (2012) Dialysis modality preference of patients with CKD and family caregivers: a discrete-choice study. American Journal of Kidney Diseases, 60 1: 102-111. doi:10.1053/j.ajkd.2011.12.030

Author Morton, Rachael L.
Snelling, Paul
Webster, Angela C.
Rose, John
Masterson, Rosemary
Johnson, David W.
Howard, Kirsten
Title Dialysis modality preference of patients with CKD and family caregivers: a discrete-choice study
Journal name American Journal of Kidney Diseases   Check publisher's open access policy
ISSN 0272-6386
Publication date 2012-07
Sub-type Article (original research)
DOI 10.1053/j.ajkd.2011.12.030
Volume 60
Issue 1
Start page 102
End page 111
Total pages 10
Place of publication Maryland Heights, MO, United States
Publisher W.B. Saunders
Collection year 2013
Language eng
Formatted abstract
Dialysis modality preferences of patients with chronic kidney disease (CKD) and family caregivers are important, yet rarely quantified.

Study Design:

Prospective, unlabeled, discrete-choice experiment with random-parameter logit analysis.

Setting & Participants:

Adults with stages 3-5 CKD and caregivers educated about dialysis treatment options from 8 Australian renal clinics.

Preferences for and trade-offs between the dialysis treatment attributes of life expectancy, number of hospital visits per week, ability to travel, hours per treatment, treatment time of day, subsidized transport service, and flexibility of treatment schedule.

Outcomes & Measurements:
Results presented as ORs for preferring home-based or in-center dialysis to conservative care.

105 predialysis patients and 73 family caregivers completed the study. Median patient age was 63 years, and mean estimated glomerular filtration rate was 18.1 (range, 6-34) mL/min/1.73 m 2. Median caregiver age was 61 years. Home-based dialysis (either peritoneal or home hemodialysis) was chosen by patients in 65% of choice sets; in-center dialysis, in 35%; and conservative care, in 10%. For caregivers, this was 72%, 25%, and 3%, respectively. Both patients and caregivers preferred longer rather than shorter hours of dialysis (ORs of 2.02 [95% CI, 1.51-2.70] and 2.67 [95% CI, 1.85-3.85] for patients and caregivers, respectively), but were less likely to choose nocturnal than daytime dialysis (ORs of 0.07 [95% CI, 0.01-0.75] and 0.03 [95% CI, 0.01-0.20]). Patients were willing to forgo 23 (95% CI, 19-27) months of life expectancy with home-based dialysis to decrease their travel restrictions. For caregivers, this was 17 (95% CI, 16-18) patient-months.

Data were limited to stated preferences rather than actual choice of dialysis modality.

Our study suggests that it is rare for caregivers to prefer conservative nondialytic care for family members with CKD. Home-based dialysis modalities that enable patients and their family members to travel with minimal restriction would be strongly aligned with the preferences of both parties.
Keyword Home dialysis
In-center dialysis
Conservative management
Chronic kidney disease
Discrete choice experiment
Health economics
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 37 times in Thomson Reuters Web of Science Article | Citations
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