Table 1.

Referral Decisions for Initiation of Dialysis

Reference	Population	Design	Outcomes	Results
Campbell et al.19	Physicians identified as having referred patients to the University of Missouri Health Sciences Center from 1982–1985 (n = 86)	Structured interview, referring physicians	Coded responses compared to referral status of the patient—early versus urgent	Physician factors: no identifiable characteristics differentiated early versus late referrals
				Patient factors: patient understanding, insurance status, fear of dialysis, access to treatment center, desire to stay with local MD
Mendelssohn et al.18	General and family medicine (FP) physicians (n = 489) and internal medicine (IM) physicians (n = 239) in Ontario	Mailed survey	Pre-dialysis referral threshold; dialysis (non)referral decisions; dialysis rationing	Patient factors: increasing age, increasing number of co-morbidities
Parry et al.20	General and elderly care physicians (n = 138) and nephrologists (n = 18) in England and Channel Islands	Mailed survey; brief case histories of older patients	Dialysis referral rates; dialysis acceptance rates	Patient factors: patient/family preferences, absence of liver metastases or dementia, age less than 80
McKenzie et al.24	Nephrologists in Canada (n = 116), US (n = 273), and UK (n = 144)	Mailed survey; 5 clinical cases, seriously ill ESRD patients	Decision to initiate dialysis resource scarcity	Physician factors: country of practice
				Patient factors: patient/family preferences, perceived quality of life, mental illness
				System factors: cost of dialysis
Sekkarie et al.21	Nephrologists (n = 22) and PCPs (n = 76) in West Virginia	Prospective MD survey for every patient in whom a withhold/ withdraw decision was made	Decision to withdraw dialysis Decision to withhold dialysis	Patient factors: older age, poor prognosis, patient/family refusal, dementia
Sekkarie et al.25	Canadian (n = 263) and US (n = 176) PCPs; Canadian (n = 166) and US (n = 93) nephrologists	Mailed survey using brief descriptions of 10 potential patients with ESRD	Referral for dialysis Reasons for withholding	Patient factors: older age, patient/family refusal, end-stage organ disease, frail condition, dementia, terminal cancer
Wilson et al.26	Family physicians in New York State (n = 889), Ontario (n = 612), and the south of England (n = 643)	Mailed survey; vignette-based case of age 55 woman with severe renal disease varying co-morbidities and SES	Referral rate for dialysis	Physician factors: no gender differences, in practice longer
				Patient factors: level of renal disease, older age, mental illness, ambulatory disability, cancer
Joly et al.30	Consecutive patients aged 80 or more with creatinine clearance < 10 ml/min per 1.73 m2 at university based hospital hemodialysis unit in France (n = 146)	Prospective cohort	Offering of dialysis mortality	Patient factors: gender, social isolation, functional impairment, late referral, diabetic
				1-year mortality predictors: nutritional status, late referral, functional status
Clement et al.22	Nephrologists in the Loire-Atlantique, Vendee, Iles et Vilaines, and Maine et Loire regions of France (n = 17)	In-person interview using a semi-directive questionnaire	Decision to discontinue dialysis or withhold dialysis	Patient factors: patient refusal, quality of life, autonomy, suffering, cognitive disorder, prognosis
Montgomery et al.17	Members of the Irish College of General Practitioners in urban and rural settings (n = 79)	Two-part interview using case scenarios with moderate/severe kidney disease defined by creatinine	Referral rates for specialty care	Physician factors: increased training experience with renal patients
				Patient factors: no age difference, no difference in severity of renal disease
Lambie et al.27	Nephrologist medical director of hemodialysis units in France, Germany, Italy, Spain, UK and USA (n = 242)	Survey questionnaire	Comparison: nephrologist opinion about dialysis initiation vs patient data from dialysis units	Physician factors: opinion about patient age, country of practice