Willingness of patients to switch from conventional to daily hemodialysis: looking before we leap

Purpose To evaluate the willingness of patients with end-stage renal disease to switch from conventional hemodialysis to short daily hemodialysis, and to determine what health benefits clinical trials of daily hemodialysis would have to document for patients to switch regimens. Methods We studied all patients receiving conventional hemodialysis (defined as three times per week) at three dialysis centers in Philadelphia during a 4-month period. Patients indicated their willingness to switch to daily hemodialysis (defined as six 2- to 3-hour in-center treatments per week) in each of 21 scenarios presented via an interactive computer display. We used conjoint analysis to determine how patientsʹ decisions were influenced by four attributes of daily hemodialysis: predicted life expectancy, quality of life, number of annual hospitalizations, and weekly transportation time to and from the dialysis center. Results Of 126 patients interviewed, 55 (44%) would not choose daily hemodialysis regardless of its health benefits. The remaining 71 patients (56%) indicated that they would consider switching if daily hemodialysis was shown to yield certain health benefits. Patients were more willing to switch to daily hemodialysis as the associated life expectancy and average quality of life increased, and as the number of annual hospitalizations and weekly transportation time decreased (all P<0.001). Conclusion Although daily hemodialysis has received broad support from nephrologists, funding agencies, and lawmakers as the emerging standard of care for patients with end-stage renal disease, upcoming clinical trials would have to document substantial health benefits in order for patients to switch to daily hemodialysis, and many patients may still decline this regimen regardless of the documented benefits.