Table 1.
Clinical, biochemical and organizational factors linked to unsuitability for patient modality choice
| Unsuitable for patient modality choice |
||||||||
|---|---|---|---|---|---|---|---|---|
| Factor | Patient choice | Mental | Abdominal | Physical | HD not possible | No choice (combined) | OR (95%CI) | |
| No. of patients | 1455 | 1071 (73.6) | 80 (5.5) | 116 (8.0) | 142 (9.8) | 46 (3.2) | 384 (26.4) | |
| Patient age (years) | <60 | 400 (79.3) | 25 (5.0) | 31 (6.2) | 35 (7.0) | 13 (2.6) | 104 (20.7) | |
| ≥60 | 671 (70.5) | 55 (5.8) | 85 (9.0)a | 107 (11.3)b | 33 (3.5) | 280 (29.5)c | 1.60 (1.24–2.07)c | |
| BMI (kg/m2) | <30 | 733 (75.1) | 53 (5.4) | 69 (7.1) | 89 (9.1) | 32 (3.3) | 243 (24.9) | |
| ≥29 | 196 (68.3) | 13 (4.5) | 34 (11.9)b | 31 (10.8) | 13 (4.5) | 91 (31.7)a | 1.40 (1.05–1.87)a | |
| Comorbidity | ||||||||
| Any comorbidity | No | 331 (84.0) | 14 (3.6) | 19 (4.8) | 24 (6.1) | 6 (1.5) | 63 (16.0) | |
| Yes | 740 (69.8) | 66 (6.2)a | 97 (9.1)b | 118 (11.1)c | 40 (3.8)c | 321 (30.2)c | 2.27 (1.69–3.08)c | |
| Myocardial infarction | No | 960 (74.2) | 72 (5.6) | 107 (8.3) | 116 (9.0) | 39 (3.0) | 334 (25.8) | |
| Yes | 111 (68.9) | 8 (5.0) | 9 (5.6) | 26 (16.1)b | 7 (4.4) | 50 (31.1)a | 1.29 (0.91–1.85)a | |
| Cardiac failure | No | 913 (75.1) | 67 (5.5) | 101 (8.3) | 109 (9.0) | 25 (2.1) | 302 (24.9) | |
| Yes | 158 (65.8) | 13 (5.4) | 15 (6.3) | 33 (13.8) | 21 (8.8)c | 82 (34.2)b | 1.57 (1.17–2.11)b | |
| All cardiac | No | 731 (76.2) | 46 (4.8) | 84 (8.8) | 78 (8.1) | 20 (2.1) | 228 (23.8) | |
| Yes | 340 (68.5) | 34 (6.9)a | 32 (6.6) | 64 (12.9)b | 26 (5.2)c | 156 (31.5)b | 1.47 (1.116–1.87)b | |
| Cerebrovascular | No | 961 (75.3) | 70 (5.5) | 103 (8.1) | 106 (8.3) | 37 (2.9) | 316 (24.7) | |
| Yes | 110 (61.8) | 10 (5.6) | 13 (7.3) | 36 (20.2)c | 9 (5.1)a | 68 (38.2)c | 1.88 (1.35–2.61)c,C | |
| DM | No | 703 (74.8) | 52 (5.5) | 76 (8.1) | 88 (9.4) | 21 (2.2) | 237 (25.2) | |
| Yes | 368 (71.5) | 28 (5.4) | 40 (7.8) | 54 (10.5) | 25 (4.9)b | 147 (28.5) | 1.18 (0.93–1.51) | |
| Peripheral vascular | No | 955 (74.6) | 72 (5.6) | 97 (7.6) | 120 (9.4) | 36 (2.8) | 325 (25.4) | |
| Yes | 116 (66.3) | 8 (4.6) | 19 (10.9) | 22 (12.6) | 10 (5.7)a | 59 (33.7)a | 1.49 (1.07–2.10)a | |
| Cancer | No | 923 (75.4) | 67 (5.5) | 78 (6.4) | 115 (9.4) | 41 (3.3) | 301 (24.6) | |
| Yes | 148 (64.1) | 13 (5.6) | 38 (16.5)c | 27 (11.7) | 5 (2.2) | 83 (35.9)c | 1.72 (1.28–2.32)c,A | |
| Pulmonary | No | 985 (74.7) | 71 (5.4) | 101 (7.7) | 123 (9.3) | 39 (3.0) | 334 (25.3) | |
| Yes | 86 (63.2) | 9 (6.6) | 15 (11.0) | 19 (14.0)a | 7 (5.1) | 50 (36.8)b | 1.71 (1.18–2.48)b,A | |
| Hepatic | No | 1037 (74.0) | 78 (5.6) | 112 (8.0) | 137 (9.8) | 38 (2.7) | 365 (26.0) | |
| Yes | 34 (64.2) | 2 (3.8) | 4 (7.5) | 5 (9.4) | 8 (15.1)c | 19 (35.8) | 1.59 (0.89–2.82) | |
| Previous transplant | No | 1019 (73.9) | 76 (5.5) | 107 (7.8) | 135 (9.8) | 42 (3.0) | 360 (26.1) | |
| Yes | 52 (68.4) | 4 (5.3) | 9 (11.8) | 7 (9.2) | 4 (5.3) | 24 (31.6) | 1.31 (0.79–2.15) | |
| Psychiatric | No | 1036 (74.3) | 64 (4.6) | 114 (8.2) | 134 (9.6) | 46 (3.3) | 358 (25.7) | |
| Yes | 35 (57.4) | 16 (26.2)c | 2 (3.3) | 8 (13.1) | 0 (0) | 26 (42.6)b | 2.15 (1.28–3.62)b,B | |
| Comorbidity number | 0 | 481 (78.6) | 32 (5.2) | 44 (7.2) | 45 (7.4) | 10 (1.6) | 131 (21.4) | 1.00 (Referent) |
| Subgroups | 1 | 324 (73.1) | 24 (5.4) | 42 (9.5) | 43 (9.7) | 10 (2.3) | 119 (26.9)a | 1.35 (1.01–1.79)a |
| >1 | 266 (66.5) | 24 (6.0) | 30 (7.5) | 54 (13.5)c | 26 (6.5)c | 134 (33.5)c | 1.85 (1.39–2.46)c | |
| Pre-dialysis course | ||||||||
| Late referral (<3 months before DI) | No | 843 (75.9) | 57 (5.1) | 81 (7.3) | 99 (8.9) | 31 (2.8) | 268 (24.1) | |
| Yes | 153 (62.7) | 19 (7.8) | 25 (10.2)a | 35 (14.3)b | 12 (4.9)a | 91 (37.3)c | 1.87 (1.39–2.51)c,A | |
| Suboptimal DI | No | 724 (80.2) | 35 (3.9) | 62 (6.9) | 61 (6.8) | 21 (2.3) | 179 (19.8) | |
| Yes | 346 (62.8) | 45 (8.2)c | 54 (9.8)b | 81 (14.7)c | 25 (4.5)b | 205 (37.2)c | 2.40 (1.89–3.04)c | |
| eGFR decrease 3–0 months prior to dialysis (mL/min/1.73 m2/month) |
<1 >1 |
541 (80.1) 313 (66.9) |
23 (3.4) 38 (8.1)c |
47 (7.0) 40 (8.5) |
47 (7.0) 62 (13.2)c |
15 (3.2) |
134 (19.9) 155 (33.1)c |
2.00 (1.53–2.62)c,A |
|
eGFR at DI (mL/min/1.73 m2) |
<6 | 125 (67.6) | 13 (7.0) | 15 (8.1) | 24 (13.0) | 8 (4.3) | 60 (32.4) | 1.00 (Referent) |
| 6–12 | 535 (74.8) | 39 (5.5) | 52 (7.3) | 70 (9.8) | 19 (2.7) | 180 (25.2)a | 0.70 (0.49–1.00)a | |
| >12 | 328 (73.9) | 23 (5.2) | 42 (9.5) | 33 (7.4)a | 18 (4.1) | 116 (26.1) | 0.74 (0.51–1.07) | |
| Late dialysis information (<3 months before DI) |
No Yes |
635 (79.7) 367 (65.1) |
32 (4.0) 43 (7.6) |
55 (6.9) 55 (9.8) |
57 (7.2) 72 (12.8) |
18 (2.3) 27 (4.8) |
162 (20.3) 197 (34.9) |
2.08 (1.45–2.70)c |
| Biochemistry | ||||||||
| Urea (mM) | <20 | 103 (76.9) | 6 (4.5) | 13 (9.7) | 10 (7.5) | 2 (1.5) | 31 (23.1) | 1.00 (Referent) |
| 20–29.9 | 379 (77.8) | 24 (4.9) | 38 (7.8) | 29 (6.0) | 17 (3.5) | 108 (22.2) | 0.95 (0.60–1.49) | |
| ≥30 | 552 (70.1) | 50 (6.4) | 61 (7.8) | 97 (12.3)c | 27 (3.4) | 235 (29.9) | 1.41 (0.92–2.17) | |
| Albumin (g/L) | <30 | 281 (65.0) | 34 (7.9)a | 45 (10.4)b | 51 (11.8)b | 21 (4.9)b | 151 (35.0)c | 2.15 (1.60–2.90)c,B |
| 30–34.9 | 282 (74.4) | 16 (4.2) | 31 (8.2) | 42 (11.1)a | 8 (2.1) | 97 (25.6)a | 1.38 (1.00–1.90)a | |
| ≥35 | 393 (80.0) | 27 (5.5) | 28 (5.7) | 36 (7.3) | 7 (1.4) | 98 (20.0) | 1.00 (Referent) | |
| CRP (mg/L) | <50 | 809 (77.3) | 52 (5.0) | 80 (7.6) | 74 (7.1) | 32 (3.1) | 238 (22.7) | |
| ≥50 | 153 (56.9) | 22 (8.2)b | 27 (10.0)a | 56 (20.8)c | 11 (4.1) | 116 (43.1)c | 2.58 (1.95–3.41)c,C | |
| Life-threatening cause | Not primary | 889 (77.1) | 58 (5.0) | 81 (7.0) | 96 (8.3) | 29 (2.5) | 264 (22.9) | |
| Primary | 156 (59.1) | 19 (7.2) | 31 (11.7)c | 41 (15.5)c | 17 (6.4)c | 108 (40.9)c | 2.33 (1.76–3.09)c | |
| Hospital | ||||||||
| University hospital | No | 205 (79.5) | 11 (4.3) | 19 (7.4) | 22 (8.5) | 1 (0.4) | 53 (20.5) | |
| Yes | 866 (72.3) | 69 (5.8) | 97 (8.1) | 120 (10.0) | 45 (3.8)b | 331 (27.7) | 1.48 (1.07–2.05)a | |
| Home dialysis first policy | No | 208 (73.2) | 14 (4.9) | 21 (8.1) | 38 (13.4) | 3 (1.1) | 76 (26.8) | |
| Yes | 863 (73.7) | 66 (5.6) | 95 (8.1) | 104 (8.9)a | 43 (3.7)a | 308 (26.4) | 0.98 (0.73–1.31) | |
| Physician age | <50 | 332 (77.2) | 21 (4.9) | 25 (5.8) | 34 (7.9) | 18 (4.2) | 98 (22.8) | |
| ≥50 | 304 (71.4) | 27 (6.3) | 36 (8.5) | 46 (10.8) | 13 (3.1) | 122 (28.6) | 1.36 (0.99–1.85)0.05 | |
| Physician sex | Male | 329 (76.3) | 23 (5.3) | 32 (7.4) | 39 (9.0) | 8 (1.9) | 102 (23.7) | |
| Female | 307 (72.2) | 25 (5.9) | 29 (6.8) | 41 (9.6) | 23 (5.4)b | 118 (27.8) | 1.24 (0.91–1.69) | |
Significant factors only. OR shown for no choice (combined) versus patient choice. Row percentages in brackets. Bold type: independent significant factors on multivariable analysis; 132 patients were excluded (106 were not assessed and 26 patients died).
Univariate analysis: aP < 0.05, bP < 0.01, cP < 0.001. Multivariable analysis: AP < 0.05, BP < 0.01, CP < 0.001. Only variables significant in the univariate analysis were included in the multivariable analysis.