(HealthDay News) — The initiation of maintenance dialysis reflects an interplay between the care practices of physicians, sources of momentum for initiation, and physician-patient interactions, according to a study published online in JAMA Internal Medicine.

Susan P.Y. Wong, MD, from the University of Washington in Seattle, and colleagues examined the factors influencing the timing of the initiation of dialysis in clinical practice. They conducted a quantitative analysis using electronic medical records from the Department of Veterans Affairs of a national random sample of 1,691 patients.

The researcher found that 74.7% of the patients initiated dialysis as inpatients and 72.6% initiated dialysis with a hemodialysis catheter. In the year prior to dialysis initiation, cohort members met with a nephrologist during an outpatient visit a median of 3 times. The interplay between at least 3 processes was reflected in the timing of the initiation of dialysis. These factors were physician practices, which varied from preparation of patients for dialysis to forestalling the need for dialysis with medical interventions; sources of momentum, which included clinical events involving acute illness or medical procedures that often precipitated dialysis initiation; and patient-physician dynamics, with interactions sometimes adversarial.

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“Our findings suggest opportunities to improve communication between patients and physicians and to better align these processes with patients’ values, goals, and preferences,” the authors write.

One author disclosed financial ties to UpToDate.


  1. Wong SPY, Vig EK, Taylor JS, et al. Timing of Initiation of Maintenance Dialysis. JAMA Intern Med. doi:10.1001/jamainternmed.2015.7412. 
  2. Potluri VS, Dember LM, Reese PP. Honoring Patient Preferences in Initiation of Dialysis. JAMA Intern Med. doi:10.1001/jamainternmed.2015.7796.