1
|
Nel H, Debbie F, Narelle H, Sean R, Aron C. A retrospective clinical and economic analysis of an assisted automated peritoneal dialysis programme in Western Australia . Perit Dial Int 2024; 44:203-210. [PMID: 37635394 DOI: 10.1177/08968608231190772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Assisted peritoneal dialysis (aPD) represents an alternative kidney replacement therapy for dialysis-dependent patients whose only other options are prolonged hospitalisations or transfer to in-centre haemodialysis (HD). Most programmes have not examined the role of temporary aPD, and there is limited data surrounding the economic implications of temporary aPD programmes. The main aim of this study was to describe the cost-effectiveness of an assisted automated peritoneal dialysis (aAPD) programme, for patients whose only reason to stay in hospital was the temporary inability to independently perform PD at home. METHODS Retrospective, single-centre analysis of 45 referrals for aAPD from November 2015 to May 2021. Two groups of patients were enrolled in the study: respite patients already established on PD (to facilitate discharge or prevent admission) and new patients who were not yet trained (to facilitate discharge). To calculate the cost differential, patients were allocated to either staying in hospital or transferring to centre-based HD with comparison to costs on aAPD. Costs were calculated using a healthcare system perspective over the duration of aAPD assistance. Clinical outcomes including peritonitis rate, hospitalisation and mortality were also assessed. RESULTS Overall, 1349 episodes of aAPD care were delivered. One thousand forty-two episodes (77%) were for respite patients and 307 episodes (23%) were for new patients awaiting training. The mean duration of assistance was 18 days for pretraining patients and 37 days for respite patients. Overall, the mean length of stay on the programme was 30 days with a range of 1-263 days (SD 43) and 73% of patients graduated to self-care PD. The cost of the aAPD programme was $242 per visit, with an average cost $7260 per patient-episode. The aAPD programme was significantly cheaper than the alternatives, with average hospitalization costs $46,170 per episode, and in-centre HD costs of $9667. $1.497 million was saved over the course of the study. Eleven hospitalisations occurred and the peritonitis rate was 0.8 episodes per patient-year. Two patients died while on aAPD. CONCLUSION This study provides the first detailed description of an aAPD respite programme in Australia. We conclude that the implementation of a temporary aAPD programme could lead to a significant reduction in healthcare costs, however peritonitis rates were high.
Collapse
Affiliation(s)
- Henco Nel
- Renal Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- HomeLink Service, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Fortnum Debbie
- Renal Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Hawkins Narelle
- HomeLink Service, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Randall Sean
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Chakera Aron
- Renal Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| |
Collapse
|
2
|
Shah N, Bennett PN, Cho Y, Leibowitz S, Abra G, Kanjanabuch T, Baharani J. Exploring Preconceptions as Barriers to Peritoneal Dialysis Eligibility: A Global Scenario-Based Survey of Kidney Care Physicians. Kidney Int Rep 2024; 9:941-950. [PMID: 38765569 PMCID: PMC11101779 DOI: 10.1016/j.ekir.2024.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Despite the growing number of patients requiring kidney replacement therapy (KRT), peritoneal dialysis (PD) is underutilized globally. A contributory factor may be clinician myths about its use. The aim of this study was to explore perceptions about PD initiation by clinicians according to various physical, social, and clinical characteristics of patients. Methods An online global survey (in English and Thai) was administered to ascertain nephrologists' and nephrology trainees' decisions on recommending PD as a treatment modality. Results A total of 645 participants (522 nephrologists and 123 trainees; 56% male) from 54 countries (66% from high-income countries [HICs], 22% from upper middle-income countries [UMICs], 12% from lower middle-income countries, and 1% from low-income countries [LICs]) completed the survey. Of the respondents, 81% identified as attending physicians or consultants, and 19% identified as trainees or other. PD was recommended for most scenarios, including repeated exposures to heavy lifting, swimming (especially in a private pool and ocean), among patients with cirrhosis or cognitive impairment with available support, and those living with a pet if a physical separation can be achieved during PD. Certain abdominal surgeries were more acceptable to proceed with PD (hysterectomy, 90%) compared to others (hemicolectomy, 45%). Similar variation was noted for different types of stomas (nephrostomies, 74%; suprapubic catheters, 53%; and ileostomies, 27%). Conclusion The probability of recommending PD in various scenarios was greater among clinicians from HICs, larger units, and consultants with more clinical experience. There is a disparity in recommending PD across various clinical scenarios driven by experience, unit-level characteristics, and region of practice. Globally, evidence-informed education is warranted to rectify misconceptions to enable greater PD uptake.
Collapse
Affiliation(s)
- Nikhil Shah
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Paul N. Bennett
- Renal Nursing (Clinical & Health Sciences), University of South Australia, Adelaide, Australia
| | | | | | - Graham Abra
- Satellite Healthcare and Department of Medicine, Division of Nephrology, Stanford University School of Medicine, California, USA
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine and Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | |
Collapse
|
3
|
Sosa Barrios RH, Burguera Vion V, Fernández Lucas M, Rivera Gorrín ME. Assisted peritoneal dialysis (asPD): age is not the key. J Nephrol 2022; 35:2451-2457. [PMID: 36131133 DOI: 10.1007/s40620-022-01420-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) has multiple advantages over other dialysis modalities. As a home-based therapy, it allows patients to keep their autonomy, avoid frequent hospital visits and carry on with their usual lifestyle. However, as a self-care therapy, dependency has been traditionally considered a contraindication. However, assistance to perform PD (asPD) can be provided regardless of the patient's age and the duration of such help. This paper is aimed at reporting on assisted PD use in a Spanish Center, and is the first report on asPD from this country. METHODS We retrospectively reviewed the electronic medical records of all patients consecutively treated with PD between May 1997 and December 2020 in our PD Unit. Assisted PD was defined as PD treatment requiring the help of another person. On the basis of the duration of dependency, we divided our cohort into: Group 1: Patients totally dependent at the start of PD treatment; Group 2: self-care patients that developed total dependency during follow up; Group 3: patients who needed short-term PD assistance. Group 4, consisting of 175 self-care PD, served as the control group. RESULTS Seventy-three percent of patients who required asPD did so during their follow up, showing that an important proportion of patients may require some help even if they were autonomous at the beginning of PD. Even for short time periods, asPD should be an option, as up to 44% of autonomous PD patients became dependent for different reasons over time. Spouses were the most frequent caregivers and absence or loss of caregiver was a main reason for switching to hemodialysis. Fourteen percent of the patients received asPD as palliative care, with clinical symptoms and perceived well-being as the main treatment goals, with adequate results. The need for support and the quality of life were periodically discussed by patients, family members and hospital staff. CONCLUSION Assisted PD is a safe option for dependent patients, young or elderly, and may result less expensive for our healthcare system, even when caregivers receive a financial incentive.
Collapse
Affiliation(s)
- R Haridian Sosa Barrios
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Ctra Colmenar Viejo km 9.1, 28034, Madrid, Spain.
| | - Víctor Burguera Vion
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Ctra Colmenar Viejo km 9.1, 28034, Madrid, Spain
| | - Milagros Fernández Lucas
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Ctra Colmenar Viejo km 9.1, 28034, Madrid, Spain.,Universidad de Alcalá de Henares, UAH, Madrid, Spain
| | - Maite E Rivera Gorrín
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Ctra Colmenar Viejo km 9.1, 28034, Madrid, Spain.,Universidad de Alcalá de Henares, UAH, Madrid, Spain
| |
Collapse
|
4
|
Huang J, Gu A, Li N, He Y, Xie W, Fang W, Yuan J, Jiang N. Self-care or assisted PD: development of a new approach to evaluate manual peritoneal dialysis practice ability. Ren Fail 2022; 44:1319-1325. [PMID: 35930437 PMCID: PMC9359159 DOI: 10.1080/0886022x.2022.2108448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Peritoneal dialysis (PD) is a home-based therapy which requires the patients or their caregivers to perform the practice. We aimed to develop a practical approach to evaluate PD practice ability of the patients and to identify berries to self-care PD. Methods A structural form was designed comprising measures of physical, cognitive, and operational abilities which were required to perform manual PD independently. The evaluation was jointly conducted by a PD nurse, a nephrologist and a close family member of the patient. Patients who met all the requirements were deemed as capable of performing PD independently (self-care PD) and others were deemed as needing an assistant (assisted PD). Results The evaluation form was applied in 280 prevalent PD patients and 33.9% of them were assessed as needing assisted PD, mainly due to physical (62.1%) or operational (66.3%) disabilities. The evaluation result was consistent with current dialysis status in 79.3% patients and it matched better in patients who performed PD with the help of an assistant (93.0 vs. 76.8%, p = 0.014). Patients who were evaluated as having barriers to self-care PD but still performed PD without an assistant were older and demonstrated higher prevalence of diabetic nephropathy and PD-related infection, lower education level, and lower serum albumin (p < 0.05). Conclusions The PD practice ability assessment form is useful to identify patients with barriers to self-care PD. It provides objective information to the patients and their family to choose feasible PD practice modality, self-care, or assisted PD.
Collapse
Affiliation(s)
- Jiaying Huang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai Jiaotong University, Shanghai, PR China
| | - Aiping Gu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai Jiaotong University, Shanghai, PR China
| | - Na Li
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai Jiaotong University, Shanghai, PR China
| | - Yanna He
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai Jiaotong University, Shanghai, PR China
| | - Weizhen Xie
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai Jiaotong University, Shanghai, PR China
| | - Wei Fang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai Jiaotong University, Shanghai, PR China
| | - Jiangzi Yuan
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai Jiaotong University, Shanghai, PR China
| | - Na Jiang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai Jiaotong University, Shanghai, PR China
| |
Collapse
|
5
|
Abstract
Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous potential advantages, including a simpler technique, greater feasibility of use in remote communities, generally lower cost, lesser need for trained staff, fewer management challenges during natural disasters, possibly better survival in the first few years, greater ability to travel, fewer dietary restrictions, better preservation of residual kidney function, greater treatment satisfaction, better quality of life, better outcomes following subsequent kidney transplantation, delayed need for vascular access (especially in small children), reduced need for erythropoiesis-stimulating agents, and lower risk of blood-borne virus infections and of SARS-CoV-2 infection. PD outcomes have been improving over time but with great variability, driven by individual and system-level inequities and by centre effects; this variation is exacerbated by a lack of standardized outcome definitions. Potential strategies for outcome improvement include enhanced standardization, monitoring and reporting of PD outcomes, and the implementation of continuous quality improvement programmes and of PD-specific interventions, such as incremental PD, the use of biocompatible PD solutions and remote PD monitoring. The use of peritoneal dialysis (PD) can be advantageous compared with haemodialysis treatment, although several barriers limit its broad implementation. This review examines the epidemiology of peritoneal dialysis (PD) outcomes, including clinical, patient-reported and surrogate PD outcomes. Peritoneal dialysis (PD) has distinct advantages compared with haemodialysis, including the convenience of home treatment, improved quality of life, technical simplicity, lesser need for trained staff, greater cost-effectiveness in most countries, improved equity of access to dialysis in resource-limited settings, and improved survival, particularly in the first few years of initiating therapy. Important barriers can hamper PD utilization in low-income settings, including the high costs of PD fluids (owing to the inability to manufacture them locally and the exorbitant costs of their import), limited workforce availability and a practice culture that limits optimal PD use, often leading to suboptimal outcomes. PD outcomes are highly variable around the world owing in part to the use of variable outcome definitions, a heterogeneous practice culture, the lack of standardized monitoring and reporting of quality indicators, and kidney failure care gaps (including health care workforce shortages, inadequate health care financing, suboptimal governance and a lack of good health care information systems). Key outcomes include not only clinical outcomes (typically defined as medical outcomes based on clinician assessment or diagnosis) — for example, PD-related infections, technique survival, mechanical complications, hospitalizations and PD-related mortality — but also patient-reported outcomes. These outcomes are directly reported by patients and focus on how they function or feel, typically in relation to quality of life or symptoms; patient-reported outcomes are used less frequently than clinical outcomes in day-to-day routine care.
Collapse
|
6
|
Late Dialysis Modality Education Could Negatively Predict Peritoneal Dialysis Selection. J Clin Med 2022; 11:jcm11144042. [PMID: 35887805 PMCID: PMC9315828 DOI: 10.3390/jcm11144042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022] Open
Abstract
Patients with end-stage renal disease are less likely to choose peritoneal dialysis (PD) as renal replacement therapy (RRT). The reasons for this biased selection are still poorly understood. In this study, we evaluated the effect of the timing of RRT education on PD selection. This single-center retrospective observational study included patients who initiated maintenance dialysis at our hospital between April 2014 and July 2021. A logistic regression analysis was performed to investigate the association of RRT education timing with PD selection. Among the 355 participants (median age [IQR] 70 (59−79) years; 28.7% female), 53 patients (14.9%) and 302 patients (85.1%) selected PD and hemodialysis, respectively. Multivariate analysis demonstrated that high estimated glomerular filtration (eGFR) at RRT education positively predicted PD selection (p < 0.05), whereas old age (p < 0.01) and high Charlson comorbidity index (p < 0.05) were negative predictors of PD selection. Female sex (p = 0.44), welfare public assistance (p = 0.78), living alone (p = 0.25), high geriatric nutritional risk index (p = 0.10) and high eGFR at first visit to the nephrology department (p = 0.83) were not significantly associated with PD selection. Late RRT education could increase the biased selection of dialysis modality.
Collapse
|
7
|
Jiang C, Zheng Q. Outcomes of peritoneal dialysis in elderly vs non-elderly patients: A systemic review and meta-analysis. PLoS One 2022; 17:e0263534. [PMID: 35134073 PMCID: PMC8824377 DOI: 10.1371/journal.pone.0263534] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/21/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives Several studies have compared outcomes of peritoneal dialysis (PD) between elderly and non-elderly patients but with variable results. We hereby designed this review to compare mortality, peritonitis, and technique survival between elderly and non-elderly patients on PD. Methods PubMed, Embase, and Google Scholar were searched for studies comparing outcomes of PD between elderly and non-elderly patients. The last search date was 14th July 2021. Results Fourteen studies were included. 12 studies defined the elderly as ≥65 years of age and these were included in the meta-analysis. Pooled analysis of crude (RR: 2.45 95% CI: 1.36, 4.40 I2 = 97% p = 0.003) and adjusted data (HR: 2.80 95% CI: 2.45, 3.09 I2 = 0% p<0.00001) indicated a statistically significant increased risk of mortality amongst elderly patients as compared to non-elderly patients. Meta-analysis of four studies demonstrated a statistically significant increased risk of peritonitis in the elderly (RR: 1.56 95% CI: 1.18, 2.07 I2 = 76% p = 0.002). Pooled analysis demonstrated no statistically significant difference in technique survival between the two groups (RR: 0.95 95% CI: 0.86, 1.05 I2 = 86% p = 0.32). Conclusion Elderly patients on PD have a significantly increased risk of mortality as compared to non-elderly patients. The risk of peritonitis is also significantly increased in older adults but the increased age has no impact on technique survival. Further studies are needed to strengthen our conclusions.
Collapse
Affiliation(s)
- Chunling Jiang
- Department of nephrology, The affiliated People’s Hospital with Jiangsu University, Zhenjiang, Jiangsu, P.R.China
- * E-mail:
| | - Qiang Zheng
- Department of nephrology, The affiliated People’s Hospital with Jiangsu University, Zhenjiang, Jiangsu, P.R.China
| |
Collapse
|
8
|
Giuliani A, Sgarabotto L, Manani SM, Tantillo I, Ronco C, Zanella M. Assisted peritoneal dialysis: strategies and outcomes. RENAL REPLACEMENT THERAPY 2022; 8:2. [PMID: 35035998 PMCID: PMC8744043 DOI: 10.1186/s41100-021-00390-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/18/2021] [Indexed: 12/01/2022] Open
Abstract
Assisted peritoneal dialysis (asPD) is a modality intended for not self-sufficient patients, mainly elderly, who are not able to perform peritoneal dialysis (PD) alone and require some help to manage the treatment. In the last decades, many countries developed strategies of asPD to face with aging of dialysis population and give an answer to the increasing demand of health service for elderly. Model of asPD varies according to the type of assistants employed and intensity of assistance provided. Both health care and non-health care assistants have been used with good clinical results. A mixed model of help, using different professional figures for short time or for longer according to patients’ need, has been proved successful and cost-effective. Outcomes of asPD are reported in different ways, and the comparative effect of asPD is unclear. Quality of life has rarely been evaluated; however, patients seem to be satisfied with the assistance provided, since it allows them to both retain independence and to be relieved from the burden of self-care. Assisted PD should not be intended as a PD-favoring strategy, but as a model that allows home dialysis also in patients who would not be eligible for PD because of social, cognitive or physical barriers.
Collapse
Affiliation(s)
- Anna Giuliani
- Department of Nephrology Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Luca Sgarabotto
- Department of Nephrology Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Sabrina Milan Manani
- Department of Nephrology Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Ilaria Tantillo
- Department of Nephrology Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Monica Zanella
- Department of Nephrology Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| |
Collapse
|