Patient education and access of ESRD patients to renal replacement therapies beyond in-center hemodialysis

Rajnish Mehrotra*, Douglas Marsh, Edward Vonesh, Vickie Peters, Allen Nissenson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

239 Scopus citations


Background. Nephrologists report that patients' choice should play an important role in the selection of renal replacement therapy (RRT) for end-stage renal disease (ESRD). In the United States, kidney transplant rates remain low and <10% of patients utilize home dialysis therapies. This study examined the effect of pre-ESRD processes on the selection of RRT among incident ESRD patients. Methods. Using surveys, data were collected for all patients admitted to 229 dialysis units in ESRD Network 18 between April 1, 2002 and May 31, 2002. A total of 1365 patients began chronic dialysis and 1193 facility (87%) and 428 patient (31%) surveys were returned. Results. Substantial proportions of patients were unaware of their kidney disease (36%) or were not seeing a nephrologist (36%) until <4 months before first dialysis. The presentation of treatment options was delayed (48% either after or < 1 month before the first dialysis). The majority of ESRD patients were not presented with chronic peritoneal dialysis, home hemodialysis, or renal transplantation as options (66%, 88%, and 74%, respectively). Using multivariate analyses, variables significantly associated with selection of chronic peritoneal dialysis as dialysis modality were the probability of chronic peritoneal dialysis being presented as a treatment option and the time spent on patient education. Conclusion. An incomplete presentation of treatment options is an important reason for under-utilization of home dialysis therapies and probably delays access to transplantation. Improvements in and reimbursement for pre-ESRD education could provide an equal and timely access for all medically suitable patients to various RRTs.

Original languageEnglish (US)
Pages (from-to)378-390
Number of pages13
JournalKidney international
Issue number1
StatePublished - Jul 2005


  • Hemodialysis
  • Home hemodialysis
  • Modality selection
  • Patient education
  • Peritoneal dialysis
  • Transplantation

ASJC Scopus subject areas

  • Nephrology


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