Nephrologist-directed primary health care in chronic dialysis patients.

We previously found that chronic in-center hemodialysis patients relied on their nephrologists for the management of acute illnesses and comorbid chronic illnesses, such as diabetes mellitus and heart disease. Since chronic peritoneal dialysis differs from in-center hemodialysis, particularly in patients' exposure to nephrologists and other dialysis unit personnel, we asked chronic peritoneal dialysis patients about their reliance on nephrologists for general health care and compared their responses to those of in-center hemodialysis patients. A questionnaire consisting of patient demographic information and questions about primary medical care was completed by 118 chronic dialysis patients (74 in-center hemodialysis patients and 44 chronic peritoneal dialysis patients). Peritoneal dialysis patients were younger (mean age, 46 +/- 17 years v 56 +/- 17 years for hemodialysis patients, P < 0.005) and fewer had been on dialysis for more than 3 years (32% v 65%, P < 0.005). Seventy-one percent of all patients did not have a family physician (84 patients). More peritoneal dialysis patients had a family physician (43% v 20%, P < 0.025), but the proportion of hemodialysis and peritoneal dialysis patients who had seen their family physician within 6 months was similar (73% and 47%, respectively, P = 0.12). Most patients relied on their nephrologist for yearly physicals (80% of hemodialysis and 84% of peritoneal dialysis patients). More hemodialysis patients depended on nephrologists for the management of minor acute illnesses (91% v 64%, P < 0.005). At least 60% of chronic health problems were managed by the nephrologists and was not different among the two patient groups.(ABSTRACT TRUNCATED AT 250 WORDS)