Evaluating Factors Contributing to Dropout in a Large Peritoneal Dialysis Program

Rate and reasons for peritoneal dialysis dropout following haemodialysis to peritoneal dialysis switch: a systematic review and meta-analysis

BACKGROUND

Patient experiences and survival outcomes can be influenced by the circumstances related to dialysis initiation and subsequent modality choices. This systematic review and meta-analysis aimed to explore the rate and reasons for peritoneal dialysis (PD) dropout following haemodialysis (HD) to PD switch.

METHOD

This systematic review conducted searches in four databases, including Medline, PubMed, Embase, and Cochrane. The protocol was registered on PROSPERO (study ID: CRD42023405718). Outcomes included factors leading to the switch from HD to PD, the rate and reasons for PD dropout and mortality difference in two groups (PD first group versus HD to PD group). The Critical Appraisal Skills Programme (CASP) checklist and the GRADE tool were used to assess quality.

RESULTS

4971 papers were detected, and 13 studies were included. On meta-analysis, there was no statistically significant difference in PD dropout in the PD first group (OR: 0.81; 95%CI: 0.61, 1.09; I2 = 83%; P = 0.16), however, there was a statistically significant reduction in the rate of mortality (OR: 0.48; 95%CI: 0.25, 0.92; I2 = 73%; P = 0.03) compared to the HD to PD group. The primary reasons for HD to PD switch, included vascular access failure, patient preference, social issues, and cardiovascular disease. Causes for PD dropout differed between the two groups, but inadequate dialysis and peritonitis were the main reasons for PD dropout in both groups.

CONCLUSION

Compared to the PD first group, a previous HD history may not impact PD dropout rates for patients, but it could impact mortality in the HD to PD group. The reasons for PD dropout differed between the two groups, with no statistical differences. Psychosocial reasons for PD dropout are valuable to further research. Additionally, establishing a consensus on the definition of PD dropout is crucial for future studies.

Remote monitoring as a surveillance method in patients on automated peritoneal dialysis for preventing complications and COVID-19 contagion

BACKGROUND

Due to the health emergency of COVID-19, telemedicine has become more relevant. Remote monitoring conspicuous as a valuable tool for the clinical follow-up of kidney patients, in this case, who are treated with automated peritoneal dialysis. This study aims to describe the use of remote monitoring as a surveillance method in a cohort of patients on automated peritoneal dialysis prevent complications and COVID-19 contagion.

METHODS

Study of a cohort of patients who initially participated in a randomized block clinical trial in which the use of Automated Peritoneal Dialysis with Remote Monitoring (APD-RM) was compared with conventional treatment. A descriptive analysis was performed of the rates of infection by COVID-19, the time of incidence until this, mortality, and rates of transfer to hemodialysis. In addition, survival was measured by survival curves.

RESULTS

Of the 509 patients, 19 were positive for COVID-19 (incidence rate of 7.0 episodes/100 patient-year), and only six patients recovered from the infection; the death rate was 2.6 % compared to all-cause death of 9.8 %. The most affected group of patients were those over 50 years old, with 71.4 % mortality, in contrast to younger patients infected, with a mortality of 60 %. During the follow-up period, 21 patients were transferred to HD: six due to peritonitis, five due to UF failure, seven due to catheter dysfunction, one due to uremic syndrome, one due to COVID-19, and one by surgical intervention.

CONCLUSION

APD-RM patients have a significant advantage over other dialysis therapies because the use of telemedicine not only provides continuity in the patient's clinical treatment but also favors the prevention of COVID-19 infection, the management and prevention of complications inherent to therapy and the preservation of the life of Peritoneal Dialysis patients.

Why Peritoneal Dialysis is Underutilized in the United States: A Review of Inequities

Given a choice, most patients with end-stage renal disease prefer home dialysis over in-center hemodialysis (HD). Peritoneal dialysis (PD) is a home dialysis method and offers benefits such as absence of central venous access and therefore preservation of veins, low cost, and decreased time per dialysis session, as well as convenience. Survival rate for patients on PD has increased to levels comparable to in-center HD. Despite endorsement by leaders in the medical field, professional societies, and those in government, PD has reached only 11% adoption among incident patients according to the 2019 United States Renal Data System Annual Data Report. This figure is dwarfed in comparison to rates as high as 79% in other countries. In addition, research has shown that inequities exist in PD access, which are most pronounced in rural, minority, and low-income regions as demonstrated by trends in regional PD supplies. To complicate things further, technique failure has been implicated as a major determinant of poor PD retention rates. The low initiation and retention rates of PD in the United States points to barriers within the healthcare system, many of which are in the early phases of being addressed.