The best dialysis therapy? Results from an international survey among nephrology professionals

Background. There is little evidence for superior outcome of one dialysis therapy versus another. Still, nephrologists have to prescribe dialysis every day. It is therefore of interest to ascertain the opinion among nephrology professionals regarding which therapy they consider to be the best and to compare this to reality. Methods. We designed a survey addressing these questions and distributed it at five international dialysis and nephrology congresses during 2007. Results. Responses were collected from 6595 delegates, 57% physicians and 28% nurses. Peritoneal dialysis (PD) was considered the best initial dialysis therapy for a planned start in a typical patient. The dialysis treatment chosen to be best for long-term use was home/self-care dialysis applied >3 times/week. The best extracorporeal form of dialysis among European respondents was high-volume haemodiafiltration (HDF), while the Asians and Americans gave preference to high-flux haemodialysis (HD). Only 7% preferred low-flux HD. Finally, the respondents were asked what level of evidence they would require to consider one form of dialysis superior to another. The majority wanted hard evidence, i.e. improved survival, to make such a distinction. Conclusions. The view of nephrology professionals on the value of different dialysis therapies reflects current scientific discussions. They consider PD to be the best initial therapy and frequent application of home/self-care dialysis to be the best long-term therapy. High-flux membranes are strongly preferred for any extracorporeal form of therapy, and HDF seems to be the modality of choice among Europeans. The opinions expressed are far from reality, which we interpret to show that non-medical factors have a strong impact on treatment allocation.