Opinion of French nephrologists on renal replacement therapy: Survey on their personal choice

Abstract

Background: In France, like in most developed countries, peritoneal dialysis (PD) is less used than haemodialysis (HD). This is not based on medical evidence supporting HD superiority. As the practitioner-fs opinion is important to patients and may influence their treatment choice, we conducted a survey among French nephrologists to determine which renal replacement therapy (RRT) they would choose if they had end-stage renal disease (ESRD). Methods: We e-mailed a self-administered questionnaire to all members of the French-speaking Nephrology Society between 19 October 2008 and 12 January 2009. We then selected from the French Renal Epidemiology and Information Network (REIN) registry a reference population of 20-to 64-year-old patients with ESRD who began RRT [HD, PD or pre-emptive transplantation, (PT)] in 2008. Results: The survey response rate was 17.8%. Results showed that 59.6% of respondents chose early inscription on the transplantation waiting list in view of PT, 20.2% selected HD and 20.2% selected PD. When dialysis was the only choice, 50.2% chose HD and 49.8% chose PD. Younger nephrologists (.44 years old) selected PD more frequently than older nephrologists (≥45 years old) (58.9 versus 40.5%; P < 0.01). Similarly, PD was chosen more often by nephrologists from regions with -emore PD-f than from regions with -eless PD-f (79.0 versus 48.8%; < 0.05). The nephrologists-f choiceswere different from the RRT distribution among the reference population: 81.7% HD, 10.1% PD and 8.2% PT. Conclusion: Our survey on the theoretical choice of RRT suggests that the low PD rate in France cannot be explained by a negative opinion of PD among French nephrologists.