6.1]) and more likely to utilize PD (39% vs 23%, P = .009). An earlier study from the same research group also used a multidisciplinary team to identify medical, psychological, and social conditions that could be barriers to PD.83 A control group was included and consisted of patients who lived in regions without home care support. Of the 134 incident patients enrolled, 108 (81%) had at least one medical (decreased strength, manual dexterity, vision, or hearing, or immobility), psychological (anxiety, decreased cognition, psychiatric condition, history of non-compliance) or social (living alone and requiring assistance, residence or nursing home doesn’t permit/support PD) barrier to PD. Each condition acting as a barrier reduced the odds of being eligible for PD. There was no difference in the likelihood of 43 Home-based versus In-center Dialysis Evidence-based Synthesis Program choosing PD or the utilization of PD based on the availability of home care. Female patients and those receiving pre-dialysis care (at least 4 months of nephrology care) were more likely to choose and utilize PD. Patients living in a region with home care assistance, choosing PD, and consenting to follow-up had a mean rate of 4.6 home care visits per week. There were no differences in hospitalizations, modality switches, or deaths among patients receiving assisted PD compared to other dialysis modalities. Nephrologists of 1,347 patients in the NECOSAD cohort were asked to provide information on patient contraindications for either PD or HD. 84 Among 225 patients with medical contraindications to PD, previous major abdominal surgery was the most common (38%) followed by cystic kidneys (7%), poor lung function (6%), chronic inflammatory bowel disease (4%), poor cardiac condition (4%), obesity (2%) and “other” (30%). Of 46 patients with medical contraindications to HD, poor cardiac condition was identified for 52%, acute start to dialysis for 7%, and “other” for 41%. There were 150 patients with social contraindications to PD. Most common was incapable of performing PD exchanges themselves (77%) with “other” for 23%. There were 4 patients with social contraindications to HD, all classified as “other.” Another study provided nephrologists with patient scenarios and asked whether they would recommend HD or PD.85 Responses from 271 nephrologists (53% response rate) were analyzed. The mean age of the nephrologists was 46 years, 85% were male, and 72% were white. Thirtyfive percent responded that they were equally trained in HD and PD while 61% were trained mostly in HD. Based on the scenarios, the nephrologists were significantly more likely to recommend PD for males, patients 51 to 65 years (compared to 30 to 50 years), patients who were compliant with treatment, patients with residual renal function above 250 ml/d of urine, and patients with an ejection fraction above 25%. They were less likely to recommended PD for patients with weight of 200 pounds or greater, patients with diabetes, and patients living alone. Race or HIV status did not independently influence the modality recommendations. Several conditions were not incorporated into the scenarios and were addressed separately. The percentage of nephrologists recommending HD over PD for different conditions was as follows: inflammatory bowel disease (96%), substance abuse (94%), malnutrition (93%), pregnancy (83%), hepatitis (40%), and myocardial infarction (33%). Ninety-eight percent of nephrologists rated patient involvement as extremely or very important followed by the nephrologist (91%), nurses and social workers (70%), family (65%), and other clinicians (12%). A study from Canada identified reasons why patients were directed to a particular modality (PD or HD). 86 Of 150 patients, HD was recommended for 31 for social reasons (65%), unusable abdomen (29%), awaiting liver transplant (3%), or age (3%). PD was recommended for 14 patients due to cardiovascular disease (71%), difficult vascular access (21%), or residence too far from center (7%). PD was also recommended for 31 patients because they were diabetic. Fiftyfive percent chose PD and 45% chose HD, primarily for social reasons. There were 74 patients with no specific condition and who were allowed free choice. Fifty percent chose HD and 50% chose PD. There was no gender preference for HD or PD. 44 Home-based versus In-center Dialysis Evidence-based Synthesis Program Home Hemodialysis Selection A recent study reported results from survey of health practitioners who visited the Nephrology Dialysis Transplantation-Educational Web site.87 The majority (61%) of responses were from Europe with 8% from North America. Among those who reported having HHD patients, the median number was 6 (range 1-150). Practitioners from dialysis units with more than 6 HHD patients were more likely to have a dedicated education team, more likely to place patients’ choice of modality above all other factors, more likely to offer choice of HHD at all stages of CKD, and more likely to believe the evidence supporting extended dialysis schedules. Practitioners from facilities that had HHD patients were more likely to see no financial disadvantage, were more likely to believe the evidence for extended HHD, and had higher expectation of the proportion of patients who could do HHD. The principal investigator