Home care assistance and the utilization of peritoneal dialysis

Optimization of Peritoneal Dialysis Services through Research Activities

Although peritoneal dialysis (PD) is an effective alternative to hemodialysis (HD) and indeed, in terms of survival, superior to HD in first year of dialysis, the utilization rate for PD remains low. Although the utilization rate of PD varies considerably, the worldwide penetration rate appears to be falling. Still, in rapidly developing countries such as China, the PD penetration rate is rising—an encouraging sign. Clearly, considerable room for improvement remains, particularly with the take-on rate of PD, and one of the potentially influential factors is the role of research activities in improving both the quantity and quality of life of patients on PD.

Costs of home assistance for peritoneal dialysis: results of a European survey

Assisted peritoneal dialysis (aPD) was 'invented' in France in 1977 and was immediately very well reimbursed. This has since helped to maintain a high French peritoneal dialysis (PD) penetration rate among elderly dependent patients who might enjoy a better quality of life by remaining in their own environment. The aim of this study was to investigate the present status of aPD funding in European countries through a questionnaire sent in 2006 to health authorities and commercial PD providers asking about reimbursement modalities (in euro ([euro]) per patient per year) for nurse aPD. Specific funding for aPD only exists in Belgium, Denmark, France, Switzerland, and one region of Spain (Canary Islands). Germany and the United Kingdom are testing pilot schemes. Compared to France, all other countries exhibit significant differences in reimbursement for similar services (performing bag exchanges or disconnections from/to a cycler, exit site care, monitoring weight as well as blood pressure and ultrafiltration, and also including transportation costs) both for continuous ambulatory peritoneal dialysis (CAPD) (23 400 vs 7280 \[euro] per patient per year in Spain) and automated peritoneal dialysis (APD) (18 200 vs 5356 euro per patient per year in Belgium); these differences are difficult to understand and might reflect disparities in cost of living, national health-care budget, and/or mean nurses' salaries. Also, there is no correlation between these rates and the reimbursement for PD therapy itself. Only France and Belgium differentiate assisted CAPD and APD, but these differences do not reflect the time really spent at the patient's home. It is concluded that high reimbursement rates for assistance add significant extra cost to PD, but allow granting many dependent patients all the advantages of home therapy, instead of treating them with in-center hemodialysis which in any case still remains more expensive for our societies.

A skeptical view of assisted home peritoneal dialysis

While assisted PD may prove helpful for a subset of new patients, its overall effect will be small. A trend towards a small increase in incident PD rate will not translate directly into an equivalent rise in PD prevalence. Important questions about cost effectiveness and about long-term impact of home PD assistance on modality distribution remain unanswered.