Fotheringham, J., Vilar, E., Bansal, T. et al. (4 more authors) (2022) Patient preferences for longer or more frequent in-center hemodialysis regimens: a multicenter discrete choice study. American Journal of Kidney Diseases, 79 (6). pp. 785-795. ISSN 0272-6386
Abstract
Rationale & Objective
Longer and more frequent hemodialysis sessions are associated with both benefits and harms. However, their relative importance to patients and how they influence acceptability for patients have not been quantified.
Study Design
Discrete-choice experiment in which a scenario followed by 12 treatment choice sets were presented to patients in conjunction with varying information about the clinical impact of the treatments offered.
Setting and Participants
Patients with kidney failure treated with maintenance dialysis for ≥1 year in 5 UK kidney centers.
Predictors
Length and frequency of hemodialysis sessions, and their prior reported associations with survival, quality of life, need for fluid restriction, hospitalization, and vascular access complications.
Outcomes
Selection of longer (4.5hr) or more frequent hemodialysis (4 sessions per week) regimens versus remaining on 3 sessions per week with session lengths of 4 hours.
Analytical Approach
Multinomial mixed effects logistic regression estimating the relative influence of different levels of the predictors on the selection of longer and more frequent dialysis, controlling for patient demographic characteristics.
Results
Among 183 prevalent in-centre haemodialysis patients (mean 4.7 years on dialysis, mean age of 63.7 years), 38.3% (70/183) always chose to remain on regimens of 3 sessions per week with session duration of 4 hours. Depicted associations of increasing survival and quality of life, reduced need for fluid restriction, and avoiding additional access complications were all significantly associated with choosing longer or more frequent treatment regimes. Younger age, fatigue, previous experience of vascular access complications, absence of heart failure, and shorter travel time to dialysis centers were associated with preference for 4 sessions per week. Patients expressed willingness to trade up to 2 years of life to avoid regimens of 4 sessions per week or access complications. After applying estimated treatment benefits and harms from existing literature, the fully adjusted model revealed that 27.1% would choose longer regimens delivered 3 times per week and 34.3% would choose 4hrs 4 times per week. Analogous estimates for younger fatigued patients living near their unit were 23.5% and 62.5%, respectively.
Limitations
Estimates were based on stated preferences rather than observed behaviors. Predicted acceptance of regimens was derived from data on treatment benefits and harms largely sourced from observational studies.
Conclusions
Predicted acceptance of longer and more frequent HD regimens substantially exceeds their use in current clinical practice. These findings underscore the need for robust data on clinical effectiveness of these more intensive regimens and more extensive consideration of patient choice in the selection of dialysis regimens.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2021 The Author(s). Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
Keywords: | Longer dialysis; frequent dialysis; discrete choice experiment; health economics |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Social Sciences (Sheffield) > Department of Economics (Sheffield) |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 23 Nov 2021 14:15 |
Last Modified: | 07 Jul 2022 16:38 |
Status: | Published |
Publisher: | Elsevier BV |
Refereed: | Yes |
Identification Number: | 10.1053/j.ajkd.2021.09.012 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:180806 |