Universität zu Köln

Entemann, David Friedrich (2024). The Influence of Centre Size on the Attitude of German Nephrologists towards Administering Peritoneal Dialysis to Comorbid Patients. PhD thesis, Universität zu Köln.

PDF David Entemann Dissertation ohne Unterschrift.pdf - Accepted Version Download (1MB)

Abstract

Peritoneal dialysis (PD) is a method of renal replacement therapy that offers both medical and economic advantages. To patients it offers a safe therapy option that can be administered autonomously at home. Nevertheless, its adoption has remained slow, and most health care systems are still dominated by in-centre haemodialysis. One factor that determines overall prescription of peritoneal dialysis is the attitude of nephrologists towards the method and their confidence in administering peritoneal dialysis, especially in cases where patients present various comorbidities. This study analyses data gathered in the Mau-PD project between 2018 and 2019. A questionnaire that was sent to all nephrologists in Germany working in the ambulatory sector was analysed to determine how they perceive peritoneal dialysis, how they view their training and if they would prefer peritoneal dialysis or haemodialysis in certain cases. As a factor that may influence this inclination to favour one over the other, the size of dialysis centres in terms of absolute patient numbers was proposed as an explanatory variable in a linear regression model. So far, centre size has been studied in its effect on mortality and technique failure; however, its effect on nephrologist attitude and ultimately prescription habits, has so far not been studied. The main findings of this study are that most German nephrologists view peritoneal dialysis as an equivalent method to haemodialysis in terms of medical outcome (90.88%). Only 23.33% of German nephrologists considered their training in peritoneal dialysis to be thorough. When presented with patients presenting various comorbidities nephrologists, on the whole, preferred haemodialysis over peritoneal dialysis (3.42884; St. Err.: 0.0173021; 95%CI: 3.394856– 3.462824; on a 5-point scale where 1 = total preference for peritoneal dialysis and 5 = total preference for haemodialysis). This general inclination was shifted towards a preference for peritoneal dialysis as absolute numbers of PD patients increased (Coefficient: -0.1672043; Std. Err.: 0.0165543; 95% CI: -0.201291 -0.135801). According to the data gathered, between 40 and 50 patients in a dialysis centre seems to be the point where a preference for haemodialysis shifts to a preference for peritoneal dialysis.