Attitudes of nephrologists towards intensified hemodialysis
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Aims: Intensified hemodialysis (HD) programs have been developed to overcome the shortcomings of conventional HD. However, them are no data on the implementation of intensified HD programs into routine care. Therefore, we investigated the attitude of nephrologists towards intensified HD, its penetrance into clinical practice, and barriers to implementation. Materials and methods: We performed an online survey within the German Society of Nephrology on the beliefs and attitudes towards intensified HD. Results: 44% of the respondents believe that there is sufficient evidence in favor of intensified HD independent of whether the respondent offers intensified HD or not. Before expanding intensified HD, adequate funding (81%) and more staff (60%) are needed. 44% of the respondents offer intensified HD to their patients. The offer of intensified HD is made to the patients mainly if the patient is not adequately treated with conventional HD (50%); only 19% offer it routinely to all patients with CKD stage 4, in preparation for renal replacement therapy. 33% of the respondents offer short daily HD, 70% nocturnal intermittent and 4% daily nocturnal. In 30% of the respondent centers, intensified dialysis is performed at home. Conclusion: Nearly one-half of the respondents already offer intensified HD. Inappropriate funding of intensified HD programs represents the most important barrier for further implementation.