Perception and Attitude Towards Home-Based Dialysis Treatments Among Patients with Chronic Kidney Disease: A Sri Lankan Single-Centre Cross-Sectional Observational Study
Dilushi Rowena Wijayaratne, Chamodi Madalagama, Sanjaykanth Nehrujee, Nushrath AliBackground
Despite the increasing prevalence of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) in Sri Lanka, the uptake of peritoneal dialysis (PD) remains low.
Materials and Methods
This was a single-center cross-sectional study among patients with stage 4-5 CKD to explore perceptions and attitudes towards home-based treatments such as PD. A two-step structured questionnaire was administered to participants. The first step involved the collection of information on socio-demographics and current awareness about PD. In the second step, all participants were presented with a standardized spoken introduction to both PD and HD, using a visual tool, delivered in their preferred language- Sinhala, Tamil or English. They were then interviewed to explore perceptions and attitudes to each type of treatment using a combination of Likert-scale response ratings, open-ended questions and checklists.
Results
144 patients were recruited (mean age - 54 years, 56% male), 64 (44%) of whom were currently on dialysis; 61 (95%) on HD, 3(5%) on PD; 56 (40%) had had no formal education, or primary level education only; 97 (67%) had a monthly income of <USD 162; 52 (36%) had heard of PD. Following the standardised introduction, 66 (46%) said they would consider a home-based treatment if offered, 39 (27%) said they would not, and 39 (27%) were uncertain. There was a significant trend towards higher likelihood of considering a home-based treatment with increasing educational status ( p <0.001) and monthly income ( p <0.01), but no association with sex, age, distance to the dialysis centre and current HD. The main attractions of home-based treatments were saving time, n = 74 (55%), lower expense, n = 52 (38%), and easier maintenance of lifestyle, n = 49 (36%). The main concerns were infection risk, n = 70 (55%), lack of confidence, n = 75 (52%), fear of emergency, n = 51 (35%), and inadequate family support, n = 31 (21%).
Conclusion
Saving time and money are important concerns for patients when selecting a dialysis modality. Adequate counseling and training may improve acceptance of PD by mitigating concerns regarding infection and self-efficacy.