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Goh BL, Lim CTS. Peritoneal dialysis catheter insertion techniques by the nephrologist. Semin Dial 2024; 37:24-35. [PMID: 35840130 DOI: 10.1111/sdi.13118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/27/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022]
Abstract
Peritoneal dialysis (PD) catheter is the lifeline of PD patients, and despite the overall strength of the PD program in many countries, PD catheter survival remains the major weakness of the program. The prompt and effective implantation of the PD catheter, as well as speedy management of complications arising from catheter insertion, remains crucial for the success of the program.
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Affiliation(s)
- Bak Leong Goh
- Department of Nephrology & Clinical Research Centre, Hospital Serdang, Kajang, Malaysia
| | - Christopher T S Lim
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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2
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Teitelbaum I, Finkelstein FO. Why are we Not Getting More Patients onto Peritoneal Dialysis? Observations From the United States with Global Implications. Kidney Int Rep 2023; 8:1917-1923. [PMID: 37849989 PMCID: PMC10577320 DOI: 10.1016/j.ekir.2023.07.012] [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] [Received: 02/08/2023] [Revised: 06/11/2023] [Accepted: 07/17/2023] [Indexed: 10/19/2023] Open
Abstract
Peritoneal dialysis (PD) offers lifestyle advantages over in-center hemodialysis (HD) and is less costly. However, in the United States, less than 12% of end-stage kidney disease (ESKD) patients are maintained on this modality. In this brief review, we discuss some of the factors underlying the low prevalence of PD. These include inadequate patient education, a shortage of sufficiently well-trained medical and nursing personnel, absence of infrastructure to support urgent start PD, and lack of support for assisted PD, among other factors. Understanding and addressing these various issues may help increase the prevalence of PD in the United States and globally.
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Affiliation(s)
- Isaac Teitelbaum
- Division of Kidney Diseases and Hypertension, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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3
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Jaelani TR, Ibrahim K, Jonny J, Pratiwi SH, Haroen H, Nursiswati N, Ramadhani BP. Peritoneal Dialysis Patient Training Program to Enhance independence and Prevent Complications: A Scoping Review. Int J Nephrol Renovasc Dis 2023; 16:207-222. [PMID: 37720493 PMCID: PMC10505035 DOI: 10.2147/ijnrd.s414447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/04/2023] [Indexed: 09/19/2023] Open
Abstract
Background Peritoneal dialysis (PD) training is essential to ensure patient independence and prevent life-threatening complications, such as peritonitis. The International Society for Peritoneal Dialysis (ISPD) recommends that every PD unit worldwide implement local PD training programs with the goal of improving self-care capabilities. This scoping review aims to give an overview of recent literature and recommendations on PD training programs aiming to improve the quality of care and outcomes for PD patients. Methods The literature search was conducted using the PC (Population, Concept) approach. The population of interest in this study is PD patients, and the study concept is the PD training program. Several databases were used to conduct the literature search, including PubMed, Science Direct, and CINAHL. The search process began from July 2022 until January 2023. The inclusion criteria for the search included research articles and recommendations. Results The search yielded 22 articles recommending training programs lasting from 5-8 days, with 1-3-hour sessions and a nurse-to-patient ratio of 1:1. A cumulative training time of 15 hours or more is recommended to enhance patient independence and reduce peritonitis rates. Home-based or in-unit PD training, conducted by experienced nurses using adult learning strategies, has shown significant value in improving self-care and preventing peritonitis. Evaluating training outcomes should encompass knowledge, skills, and attitudes, and the impact on peritonitis rates. Training programs should be flexible and consider physiological and psychosocial barriers to achieving the best results. Conclusion There are a variety of strategies for dialysis training concerning duration, session length, patient-to-trainer ratio, timing, methods, location, compliance, and the need for retraining. More evidence is needed to assess the impact of PD patient training programs on self-care capabilities and peritonitis incidence. Future studies should investigate the effects of training programs on compliance, self-efficacy, and patient and nurse perspectives.
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Affiliation(s)
| | - Kusman Ibrahim
- Faculty of Nursing, Padjadjaran University, Bandung, West Java, Indonesia
| | - Jonny Jonny
- Nephrology Division, Department of Internal Medicine, Gatot Soebroto Indonesia Army Central Hospital, Jakarta, Indonesia
| | | | - Hartiah Haroen
- Faculty of Nursing, Padjadjaran University, Bandung, West Java, Indonesia
| | | | - Bunga Pinandhita Ramadhani
- Nephrology Division, Department of Internal Medicine, Gatot Soebroto Indonesia Army Central Hospital, Jakarta, Indonesia
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4
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Tran E, Karadjian O, Chan CT, Trinh E. Home hemodialysis technique survival: insights and challenges. BMC Nephrol 2023; 24:205. [PMID: 37434110 PMCID: PMC10337160 DOI: 10.1186/s12882-023-03264-5] [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] [Received: 10/02/2022] [Accepted: 07/06/2023] [Indexed: 07/13/2023] Open
Abstract
Home hemodialysis (HHD) offers several clinical, quality of life and cost-saving benefits for patients with end-stage kidney disease. While uptake of this modality has increased in recent years, its prevalence remains low and high rates of discontinuation remain a challenge. This comprehensive narrative review aims to better understand what is currently known about technique survival in HHD patients, elucidate the clinical factors that contribute to attrition and expand on possible strategies to prevent discontinuation. With increasing efforts to encourage home modalities, it is imperative to better understand technique survival and find strategies to help maintain patients on the home therapy of their choosing. It is crucial to better target high-risk patients, examine ideal training practices and identify practices that are potentially modifiable to improve technique survival.
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Affiliation(s)
- Estelle Tran
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Oliver Karadjian
- Division of Nephrology, Department of Medicine, McGill University Health Center, 1650 Av Cedar, L4-510, Montreal, QC, H3G 1A4, Canada
| | | | - Emilie Trinh
- Division of Nephrology, Department of Medicine, McGill University Health Center, 1650 Av Cedar, L4-510, Montreal, QC, H3G 1A4, Canada.
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5
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Al Sahlawi M, Ponce D, Charytan DM, Cullis B, Perl J. Peritoneal Dialysis in Critically Ill Patients: Time for a Critical Reevaluation? Clin J Am Soc Nephrol 2023; 18:512-520. [PMID: 36754063 PMCID: PMC10103328 DOI: 10.2215/cjn.0000000000000059] [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: 01/22/2023]
Abstract
Peritoneal dialysis (PD) as an AKI treatment in adults was widely accepted in critical care settings well into the 1980s. The advent of extracorporeal continuous KRT led to widespread decline in the use of PD for AKI across high-income countries. The lack of familiarity and comfort with the use of PD in critical care settings has also led to lack of use even among those receiving maintenance PD. Many critical care units reflexively convert patients receiving maintenance PD to alternative dialysis therapies at admission. Renewed interest in the use of PD for AKI therapy has emerged due to its increasing use in low- and middle-income countries. In high-income countries, the coronavirus disease 2019 (COVID-19) pandemic, saw PD for AKI used early on, where many critical care units were in crisis and relied on PD use when resources for other AKI therapy modalities were limited. In this review, we highlight advantages and disadvantages of PD in critical care settings and indications and contraindications for its use. We provide an overview of literature to support both PD treatment during AKI and its continuation as a maintenance therapy during critical illness. For AKI therapy, we further discuss establishment of PD access, PD prescription management, and complication monitoring and treatment. Finally, we discuss expansion in the use of PD for AKI therapy extending beyond its role during times of resource constraints.
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Affiliation(s)
- Muthana Al Sahlawi
- Department of Internal Medicine, College of Medicine, King Faisal University, Al-Hasa, Saudi Arabia
| | - Daniela Ponce
- Department of Medicine, Botukatu School of Medicine, Sao Paulo, Brazil
| | - David M. Charytan
- Nephrology Division, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Brett Cullis
- Renal and Intensive Care Unit, Hilton Life Hospital, Cape Town, South Africa
- Department of Renal and Solid Organ Transplantation, Red Cross War Memorial Childrens Hospital, University of Cape Town, Cape Town, South Africa
| | - Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital, University of Toronto, Ontario, Canada
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6
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Makhyoun CN, Ullian ME. Antibiotic availability for outpatient treatment of acute peritonitis in chronic peritoneal dialysis patients: A case series. Am J Med Sci 2023; 365:263-269. [PMID: 36521531 DOI: 10.1016/j.amjms.2022.12.002] [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: 02/18/2022] [Revised: 09/07/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) is a commonly used form of renal replacement therapy for patients that have reached end-stage renal disease. Acute bacterial peritonitis (ABP) in chronic PD patients results in pain, increased costs, injury to the peritoneal membrane, and PD modality failure. Optimal antibiotic treatment of acute bacterial peritonitis (ABP) in chronic PD patients should be intraperitoneal, outpatient-based, appropriate, prompt, and uninterrupted. We investigated the frequency of and predisposition to suboptimal antibiotic courses for ABP in our chronic PD patients. METHODS Twenty-four charts of patients with ABP were reviewed, to test the null hypothesis that all ABP patients received antibiotics optimally. RESULTS After 12 patient exclusions (hospitalization), 9 suboptimal antibiotic events were detected in 6 of the remaining 12 patients, disproving the null hypothesis (p < 0.02). Most suboptimal antibiotics courses (7 of 9) resulted from delays and/or gaps in therapy or antibiotics prescribed outside of community standard. Suboptimal antibiotic events occurred on nights and weekends rather than during the workweek (p < 0.02) and in the emergency room rather than the PD clinic (p < 0.02). CONCLUSIONS Suboptimal ABP antibiotic therapy occurs commonly and is influenced by time and location of presentation and lack of knowledge by patients and physicians. Prevention of suboptimal antibiotic courses in the treatment of ABP in chronic PD patients includes education of patients and providers and allowing emergency rooms and PD clinics to dispense antibiotics for home use.
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Affiliation(s)
- Camilia N Makhyoun
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA
| | - Michael E Ullian
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA.
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7
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Dogan I, Ucar E, Oruc A, Ates K. The perception of nephrologists about peritoneal dialysis in Turkey. Ther Apher Dial 2023; 27:100-106. [PMID: 35749340 DOI: 10.1111/1744-9987.13903] [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: 02/14/2022] [Accepted: 06/22/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND We aimed to evaluate the perceptions of nephrologists about peritoneal dialysis (PD) in Turkey. MATERIALS AND METHODS An anonymous survey was conducted to a total of 150 nephrologists. Demographic data, perceptions, PD indications, contraindications, and possible reasons for low preference of PD were questioned. RESULTS In decision making, 93.4% of all stated that patients prioritized the doctor's opinion and 80.7% considered PD is the best initial dialysis option. The presence of many HD facilities (70.7%), inadequate knowledge, and education of patients (70%), physicians' reluctance to practice PD (70%), unwillingness of patients (68.7%), negative effect of other patients (67.3%), inadequate experience of PD staff (58.7%), and nonencouragement of PD by the state (58.7%) were the leading reasons of low prevalence. CONCLUSION Implementation of comprehensive predialysis education programs for patients, informing government and hospital officials about PD advantages, and reinforcing PD principles to the nephrologists could improve the low prevalence of PD in Turkey.
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Affiliation(s)
- Ibrahim Dogan
- Hitit University, Faculty of Medicine, Department of Nephrology, Corum, Turkey
| | - Emel Ucar
- Baxter International Inc., Ankara, Turkey
| | - Aysegul Oruc
- Uludag University, Faculty of Medicine, Department of Nephrology, Bursa, Turkey
| | - Kenan Ates
- Ankara University, Faculty of Medicine, Department of Nephrology, Ankara, Turkey
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8
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Propensity-matched comparison of mortality between peritoneal dialysis and hemodialysis in patients with type 2 diabetes. Int Urol Nephrol 2021; 54:1373-1381. [PMID: 34657242 DOI: 10.1007/s11255-021-03026-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: 04/08/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The optimal choice of dialysis modality for diabetic patients remains controversial. This study aimed to compare mortality between peritoneal dialysis (PD) and hemodialysis (HD) in end-stage renal disease (ESRD) patients with type 2 diabetes (T2D). METHODS Our observational, longitudinal cohort consisted of all incident ESRD patients with T2D who received either PD or HD in our center from January 2012 to December 2017 and were followed until December 2019. Propensity scores were used to select a 1:1 matched cohort. Mortality was compared between dialysis modalities using Kaplan-Meier survival analysis, and risk factors for mortality were estimated using multivariate Cox regression analyses. RESULTS The median follow-up times were 35.5 months in the PD group (n = 134) and 41.6 months in the HD group (n = 134, p = 0.0381). The 1-, 2-, 3-, 5-, and 7-year patient survival rates were 98%, 91%, 77%, 61%, and 35% for diabetic PD patients and 96%, 88%, 81%, 60%, and 57% for diabetic HD patients. Kaplan-Meier survival analysis showed that overall mortality did not significantly differ between modalities (log-rank = 0.9473, p = 0.6575). Using a multivariate Cox regression model, advanced age and increased cholesterol at the initiation of PD treatment were independent risk factors associated with mortality, whereas under HD therapy, the risk factors associated with mortality were lower BMI and higher HbA1c. CONCLUSIONS These results suggest that in patients with T2D, mortality is comparable between PD and HD irrespective of whether there are the first 2 years or over the 2-year period, and that different mortality predictor patterns exist between patients treated with PD versus HD.
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Gupta N, Taber-Hight EB, Miller BW. Perceptions of Home Dialysis Training and Experience Among US Nephrology Fellows. Am J Kidney Dis 2021; 77:713-718.e1. [DOI: 10.1053/j.ajkd.2020.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/10/2020] [Indexed: 12/16/2022]
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10
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Lakshmi S, Varalakshmi B, Sameera NS, Sunnesh A, Ram R, Kumar VS. Nephrology Postgraduate Training in Peritoneal Dialysis: An Online Survey. Indian J Nephrol 2020; 30:277-282. [PMID: 33273794 PMCID: PMC7699655 DOI: 10.4103/ijn.ijn_184_19] [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: 06/01/2019] [Revised: 09/05/2019] [Accepted: 10/18/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction: One of the reasons for the peritoneal dialysis (PD) underutilization is related to the training of nephrology postgraduates in PD. This notion is not yet investigated in our country. Methods: We gathered the emails of the heads of the departments of nephrology of all medical colleges and the institutes, which impart DM nephrology post-graduation. We sent the questionnaire framed on the postgraduate training of PD. We received the questionnaire responses anonymously. The broad headings in the questionnaire are information on training resources, training activities, perceived adequacy of the training, and the factors, which limit the utilization of PD. Results: There are 42 medical colleges and institutes (excluding Sri Venkateswara Institute of Medical Sciences) that impart DM nephrology post-graduation in our country. Of these, 30 heads of the departments had responded. More than half of the heads of the department felt that the PD training postgraduates were inadequate. When asked to describe the reason for the perceived inadequacy of PD training, the primary reason noted included was insufficient numbers of PD patients (66.67%). Discussion: The conclusion may be drawn from our study that the postgraduate training in PD in our country is gratifying. Our hypothesis that a lacuna in postgraduate training in PD may be one of the reasons for the underutilization of PD seems ungrounded.
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Affiliation(s)
- Sangeetha Lakshmi
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - B Varalakshmi
- Department of Nephrology, Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India
| | - N Sai Sameera
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - A Sunnesh
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - R Ram
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - V Siva Kumar
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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11
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Abstract
The proportion of incident U.S. patients with end-stage renal disease starting chronic peritoneal dialysis (CPD) has historically been low. The low take-on for CPD in the United States is likely multifactorial, but limited physician training and inadequate pre-dialysis patient education appear to be particularly important. Furthermore, two key changes have occurred in the United States: a steep decline in CPD take-on and a progressive increase in the use of automated peritoneal dialysis (APD). The decline in CPD take-on has affected virtually every subgroup examined and has occurred, paradoxically, when the CPD outcomes in the country have improved. Understanding the reasons for historically low CPD take-on and recent steep declines in utilization may allow for plans to reverse these trends to be developed.
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Affiliation(s)
- Rajnish Mehrotra
- Los Angeles Biomedical Research Institute, Harbor–UCLA Medical Center, Torrance, and David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, U.S.A
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12
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Rajora N, Shastri S, Pirwani G, Saxena R. How To Build a Successful Urgent-Start Peritoneal Dialysis Program. KIDNEY360 2020; 1:1165-1177. [PMID: 35368794 PMCID: PMC8815497 DOI: 10.34067/kid.0002392020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/07/2020] [Indexed: 12/15/2022]
Abstract
In-center hemodialysis (HD) remains the predominant dialysis therapy in patients with ESKD. Many patients with ESKD present in late stage, requiring urgent dialysis initiation, and the majority start HD with central venous catheters (CVCs), which are associated with poor outcomes and high cost of care. Peritoneal dialysis (PD) catheters can be safely placed in such patients with late-presenting ESKD, obviating the need for CVCs. PD can begin almost immediately in the recumbent position, using low fill volumes. Such PD initiations, commencing within 2 weeks of the catheter placement, are termed urgent-start PD (USPD). Most patients with an intact peritoneal cavity and stable home situation are eligible for USPD. Although there is a small risk of PD catheter-related mechanical complications, most can be managed conservatively. Moreover, overall outcomes of USPD are comparable to those with planned PD initiations, in contrast to the high rate of catheter-related infections and bacteremia associated with urgent-start HD. The ongoing coronavirus disease 2019 pandemic has further exposed the vulnerability of patients with ESKD getting in-center HD. PD can mitigate the risk of infection by reducing environmental exposure to the virus. Thus, USPD is a safe and cost-effective option for unplanned dialysis initiation in patients with late-presenting ESKD. To develop a successful USPD program, a strong infrastructure with clear pathways is essential. Coordination of care between nephrologists, surgeons or interventionalists, and hospital and PD center staff is imperative so that patient education, home visits, PD catheter placements, and urgent PD initiations are accomplished expeditiously. Implementation of urgent-start PD will help to increase PD use, reduce cost, and improve patient outcomes, and will be a step forward in fostering the goal set by the Advancing American Kidney Health initiative.
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Affiliation(s)
- Nilum Rajora
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Shani Shastri
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gulzar Pirwani
- University of Texas Southwestern/DaVita Peritoneal Dialysis Center, Irving, Texas
| | - Ramesh Saxena
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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13
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Wallace EL, Allon M. ESKD Treatment Choices Model: Responsible Home Dialysis Growth Requires Systems Changes. KIDNEY360 2020; 1:424-427. [PMID: 35369367 PMCID: PMC8809289 DOI: 10.34067/kid.0000672019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Eric L Wallace
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael Allon
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
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14
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Boudville N, Johnson DW, Zhao J, Bieber BA, Pisoni RL, Piraino B, Bernardini J, Nessim SJ, Ito Y, Woodrow G, Brown F, Collins J, Kanjanabuch T, Szeto CC, Perl J. Regional variation in the treatment and prevention of peritoneal dialysis-related infections in the Peritoneal Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant 2020; 34:2118-2126. [PMID: 30053214 DOI: 10.1093/ndt/gfy204] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 05/29/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Peritoneal dialysis (PD)-related infections lead to significant morbidity. The International Society for Peritoneal Dialysis (ISPD) guidelines for the prevention and treatment of PD-related infections are based on variable evidence. We describe practice patterns across facilities participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). METHODS PDOPPS, a prospective cohort study, enrolled nationally representative samples of PD patients in Australia/New Zealand (ANZ), Canada, Thailand, Japan, the UK and the USA. Data on PD-related infection prevention and treatment practices across facilities were obtained from a survey of medical directors'. RESULTS A total of 170 centers, caring for >11 000 patients, were included. The proportion of facilities reporting antibiotic administration at the time of PD catheter insertion was lowest in the USA (63%) and highest in Canada and the UK (100%). Exit-site antimicrobial prophylaxis was variably used across countries, with Japan (4%) and Thailand (28%) having the lowest proportions. Exit-site mupirocin was the predominant exit-site prophylactic strategy in ANZ (56%), Canada (50%) and the UK (47%), while exit-site aminoglycosides were more common in the USA (72%). Empiric Gram-positive peritonitis treatment with vancomycin was most common in the UK (88%) and USA (83%) compared with 10-45% elsewhere. Empiric Gram-negative peritonitis treatment with aminoglycoside therapy was highest in ANZ (72%) and the UK (77%) compared with 10-45% elsewhere. CONCLUSIONS Variation in PD-related infection prevention and treatment strategies exist across countries with limited uptake of ISPD guideline recommendations. Further work will aim to understand the impact these differences have on the wide variation in infection risk between facilities and other clinically relevant PD outcomes.
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Affiliation(s)
- Neil Boudville
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - Beth Piraino
- Department of Medicine, Renal Electrolyte Division, University of Pittsburgh, Pittsburgh, PA, USA
| | - Judith Bernardini
- Department of Medicine, Renal Electrolyte Division, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sharon J Nessim
- Department of Nephrology, Division of Nephrology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Graham Woodrow
- Department of Nephrology, St James's University Hospital, Leeds, UK
| | - Fiona Brown
- Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia
| | - John Collins
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Internal Medicine, and Kidney & Metabolic Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Cheuk-Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Jeffrey Perl
- Department of Medicine, Division of Nephrology, St. Michael's Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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15
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Mehrotra R, Burkart J. Education, Research, Peritoneal Dialysis, and the North American Chapter of the International Society for Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080502500104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Rajnish Mehrotra
- Los Angeles Biomedical Institute Harbor-UCLA Medical Center, Torrance
- The David Geffen School of Medicine at UCLA, Los Angeles, California
| | - John Burkart
- Wake Forest University School of Medicine Winston Salem, North Carolina, USA
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16
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Piccoli GB, Mezza E, Soragna G, Pacitti A, Burdese M, Gai M, Quaglia M, Fabrizio F, Anania P, Jeantet A, Segoloni GP. Teaching Peritoneal Dialysis in Medical School: An Italian Pilot Experience. Perit Dial Int 2020. [DOI: 10.1177/089686080302300314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Elisabetta Mezza
- Department of Internal Medicine University of Torino Turin, Italy
| | - Giorgio Soragna
- Department of Internal Medicine University of Torino Turin, Italy
| | - Alfonso Pacitti
- Department of Internal Medicine University of Torino Turin, Italy
| | - Manuel Burdese
- Department of Internal Medicine University of Torino Turin, Italy
| | - Massimo Gai
- Department of Internal Medicine University of Torino Turin, Italy
| | - Marco Quaglia
- Department of Internal Medicine University of Torino Turin, Italy
| | - Fop Fabrizio
- Department of Internal Medicine University of Torino Turin, Italy
| | - Patrizia Anania
- Department of Internal Medicine University of Torino Turin, Italy
| | - Alberto Jeantet
- Department of Internal Medicine University of Torino Turin, Italy
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17
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Affiliation(s)
- Beth Piraino
- University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania, USA
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18
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19
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Mehrotra R. The Continuum of Chronic Kidney Disease and End-Stage Renal Disease: Challenges and Opportunities for Chronic Peritoneal Dialysis in the United States. Perit Dial Int 2020. [DOI: 10.1177/089686080702700204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
End-stage renal disease (ESRD) patients undergoing renal replacement therapy have a high mortality rate and suffer from considerable morbidity. Degree of nutritional decline, disordered mineral metabolism, and vascular calcification are some of the abnormalities that predict an adverse outcome for ESRD patients. All these abnormalities begin early during the course of chronic kidney disease (CKD), long before the need for maintenance dialysis. Thus, CKD represents a continuum of metabolic and vascular abnormalities. Treatment of these abnormalities early during the course of CKD and a timely initiation of dialysis have the potential of improving patient outcomes. However, the thesis that successful management of these abnormalities will favorably modify the outcomes of dialysis patients remains untested.The proportion of incident USA ESRD patients starting chronic peritoneal dialysis (CPD) has historically been low. Limited physician training and inadequate predialysis patient education appear to underlie the low CPD take-on in the USA. Furthermore, two key changes have occurred in the USA: steep decline in CPD take-on and progressive increase in the use of automated peritoneal dialysis. The decline in CPD take-on has afflicted virtually every subgroup examined and has occurred, paradoxically, when the CPD outcomes in the country have improved. Understanding the reasons for historically low CPD take-on and recent steep declines in utilization may allow the development of plans to reverse these trends.
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Affiliation(s)
- Rajnish Mehrotra
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, and David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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20
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Mehrotra R. Peritoneal Dialysis Penetration in the United States: March toward the Fringes? Perit Dial Int 2020. [DOI: 10.1177/089686080602600402] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Rajnish Mehrotra
- Division of Nephrology and Hypertension and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, and David Geffen School of Medicine at UCLA Los Angeles, California, USA
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21
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Young EW, Kapke A, Ding Z, Baker R, Pearson J, Cogan C, Mukhopadhyay P, Turenne MN. Peritoneal Dialysis Patient Outcomes under the Medicare Expanded Dialysis Prospective Payment System. Clin J Am Soc Nephrol 2019; 14:1466-1474. [PMID: 31515234 PMCID: PMC6777599 DOI: 10.2215/cjn.01610219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/30/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Peritoneal dialysis (PD) use increased in the United States with the introduction of a new Medicare prospective payment system in January 2011 that likely reduced financial disincentives for facility use of this home therapy. The expansion of PD to a broader population and facilities having less PD experience may have implications for patient outcomes. We assessed the impact of PD expansion on PD discontinuation and patient mortality. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A prospective cohort study was conducted of patients treated with PD at 90 days of ESKD. Patients were grouped by study start date relative to the Medicare payment reform: prereform (July 1, 2008 to December 31, 2009; n=10,585), interim (January 1, 2010 to December 31, 2010; n=7832), and reform period (January 1, 2011 to December 31, 2012; n=18,742). Patient characteristics and facility PD experience were compared at baseline (day 91 of ESKD). Patients were followed for 3 years for the major outcomes of PD discontinuation and mortality using Cox proportional hazards models. RESULTS Patient characteristics, including age, sex, race, ethnicity, rurality, cause of ESKD, and comorbidity, were similar or showed small changes across the three study periods. There was an increasing tendency for patients on PD to be treated in facilities with less PD experience (from 34% during the prereform period being treated in facilities averaging <14 patients on PD per year to 44% in the reform period). Patients treated in facilities with less PD experience had a higher rate of PD discontinuation than patients treated in facilities with the most experience (hazard ratio [HR], 1.16; 95% confidence interval [95% CI], 1.10 to 1.23 for the first versus fifth quintile of PD experience). Nevertheless, the risk of PD discontinuation fell during the late interim period (HR, 0.88; 95% CI, 0.82 to 0.95) and most of the reform period (from HR, 0.85; 95% CI, 0.79 to 0.91 to HR, 0.94; 95% CI, 0.87 to 1.01). Mortality risk was stable across the three study periods. CONCLUSIONS In the context of expanding PD use and declining facility PD experience, the risk of PD discontinuation fell, and there was no adverse effect on mortality. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_09_12_CJN01610219.mp3.
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Affiliation(s)
- Eric W Young
- Arbor Research Collaborative for Health, Ann Arbor, Michigan; and .,University of Michigan, Ann Arbor, Michigan
| | - Alissa Kapke
- Arbor Research Collaborative for Health, Ann Arbor, Michigan; and
| | - Zhechen Ding
- Arbor Research Collaborative for Health, Ann Arbor, Michigan; and
| | | | - Jeffrey Pearson
- Arbor Research Collaborative for Health, Ann Arbor, Michigan; and
| | - Chad Cogan
- Arbor Research Collaborative for Health, Ann Arbor, Michigan; and
| | | | - Marc N Turenne
- Arbor Research Collaborative for Health, Ann Arbor, Michigan; and
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Chan CT, Wallace E, Golper TA, Rosner MH, Seshasai RK, Glickman JD, Schreiber M, Gee P, Rocco MV. Exploring Barriers and Potential Solutions in Home Dialysis: An NKF-KDOQI Conference Outcomes Report. Am J Kidney Dis 2018; 73:363-371. [PMID: 30545707 DOI: 10.1053/j.ajkd.2018.09.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/27/2018] [Indexed: 11/11/2022]
Abstract
Home dialysis therapy, including home hemodialysis and peritoneal dialysis, is underused as a modality for the treatment of chronic kidney failure. The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative sponsored a home dialysis conference in late 2017 that was designed to identify the barriers to starting and maintaining patients on home dialysis therapy. Clinical, operational, policy, and societal barriers were identified that need to be overcome to ensure that dialysis patients have the freedom to choose their treatment modality. Education of patients and patient partners, as well as health care providers, about home dialysis therapy, if offered at all, is often provided in a cursory manner. Lack of exposure to home dialysis therapies perpetuates a lack of familiarity and thus a hesitancy to refer patients to home dialysis therapies. Patient and care partner support, both psychosocial and financial, is also critical to minimize the risk for burnout leading to dropout from a home dialysis modality. Thus, the facilitation of home dialysis therapy will require a systematic change in chronic kidney disease education and the approach to dialysis therapy initiation, the creation of additional incentives for performing home dialysis, and breakthroughs to simplify the performance of home dialysis modalities. The home dialysis work group plans to develop strategies to overcome these barriers to home dialysis therapy, which will be presented at a follow-up home dialysis conference.
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Affiliation(s)
| | - Eric Wallace
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | - Joel D Glickman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Patrick Gee
- Quality Insights Renal Network 5, Mid-Atlantic Renal Coalition, North Chesterfield, VA
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Wang V, Coffman CJ, Sanders LL, Lee SYD, Hirth RA, Maciejewski ML. Medicare's New Prospective Payment System on Facility Provision of Peritoneal Dialysis. Clin J Am Soc Nephrol 2018; 13:1833-1841. [PMID: 30455323 PMCID: PMC6302340 DOI: 10.2215/cjn.05680518] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 08/31/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Peritoneal dialysis is a self-administered, home-based treatment for ESKD associated with equivalent mortality, higher quality of life, and lower costs compared with hemodialysis. In 2011, Medicare implemented a comprehensive prospective payment system that makes a single payment for all dialysis, medication, and ancillary services. We examined whether the prospective payment system increased dialysis facility provision of peritoneal dialysis services and whether changes in peritoneal dialysis provision were more common among dialysis facilities that are chain affiliated, located in nonurban areas, and in regions with high dialysis market competition. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a longitudinal retrospective cohort study of n=6433 United States nonfederal dialysis facilities before (2006-2010) and after (2011-2013) the prospective payment system using data from the US Renal Data System, Medicare, and Area Health Resource Files. The outcomes of interest were a dichotomous indicator of peritoneal dialysis service availability and a discrete count variable of dialysis facility peritoneal dialysis program size defined as the annual number of patients on peritoneal dialysis in a facility. We used general estimating equation models to examine changes in peritoneal dialysis service offerings and peritoneal dialysis program size by a pre- versus post-prospective payment system effect and whether changes differed by chain affiliation, urban location, facility size, or market competition, adjusting for 1-year lagged facility-, patient with ESKD-, and region-level demographic characteristics. RESULTS We found a modest increase in observed facility provision of peritoneal dialysis and peritoneal dialysis program size after the prospective payment system (36% and 5.7 patients in 2006 to 42% and 6.9 patients in 2013, respectively). There was a positive association of the prospective payment system with peritoneal dialysis provision (odds ratio, 1.20; 95% confidence interval, 1.13 to 1.18) and PD program size (incidence rate ratio, 1.27; 95% confidence interval, 1.22 to 1.33). Post-prospective payment system change in peritoneal dialysis provision was greater among nonurban (P<0.001), chain-affiliated (P=0.002), and larger-sized facilities (P<0.001), and there were higher rates of peritoneal dialysis program size growth in nonurban facilities (P<0.001). CONCLUSIONS Medicare's 2011 prospective payment system was associated with more facilities' availability of peritoneal dialysis and modest growth in facility peritoneal dialysis program size. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_11_19_CJASNPodcast_18_12_.mp3.
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Affiliation(s)
- Virginia Wang
- Departments of Population Health Sciences and
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Health Services Research and Development Center of Innovation, Durham Veterans Affairs Health Care System, Durham, North Carolina; and
| | - Cynthia J. Coffman
- Biostatistics and Bioinformatics and
- Health Services Research and Development Center of Innovation, Durham Veterans Affairs Health Care System, Durham, North Carolina; and
| | - Linda L. Sanders
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Shoou-Yih D. Lee
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan
| | - Richard A. Hirth
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan
| | - Matthew L. Maciejewski
- Departments of Population Health Sciences and
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Health Services Research and Development Center of Innovation, Durham Veterans Affairs Health Care System, Durham, North Carolina; and
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24
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Olszewski AE, Daniel DA, Stein DR, McCulloch MI, Su SW, Hames DL, Wolbrink TA. Teaching Pediatric Peritoneal Dialysis Globally through Virtual Simulation. Clin J Am Soc Nephrol 2018; 13:900-906. [PMID: 29720505 PMCID: PMC5989666 DOI: 10.2215/cjn.10460917] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 02/20/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite the increasing prevalence of childhood kidney disease worldwide, there is a shortage of clinicians trained to provide peritoneal dialysis (PD). E-learning technologies may provide a solution to improve knowledge in PD. We describe the development of a virtual PD simulator and report the first 22 months of online usage. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The PD simulator was developed and released on OPENPediatrics in January of 2016. A prospective study of international, multidisciplinary healthcare providers was conducted from January of 2016 through October of 2017. User action data were analyzed with descriptive statistics and linear regression. Paired t tests compared user pre- and post-test scores. User satisfaction was assessed by survey. RESULTS The simulator was accessed by 1066 users in 70 countries. Users spent a median of 35 minutes (interquartile range [IQR] 14-84) in the simulator. Users who completed the structured learning curriculum (n=300) spent a median of 85 minutes (IQR 46-95), and those who completed the entire simulator (n=63) spent a median of 122 minutes (IQR 69-195). Users who completed the simulator were more likely to scroll through text and access the simulator in multiple sessions. The 300 users that completed testing showed statistically significant increases in the post- versus pretest scores, with a mean increase of 36.4 of 100 points, SD 19.9 (95% confidence interval, 34.1 to 38.6, P<0.001). Eighty-seven percent (20 of 23) of survey respondents felt the simulator was relevant to their clinical practice, and 78% (18 of 23) would recommend it to others. CONCLUSIONS This is the first reported virtual PD simulator. Increased test scores were observed between pre- and post-tests by clinicians who completed testing, across disciplines, training levels, and resource settings.
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Affiliation(s)
- Aleksandra E. Olszewski
- Department of Pediatrics, University of Washington/Seattle Children’s Hospital, Seattle, Washington
| | - Dennis A. Daniel
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital and the Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
| | - Deborah R. Stein
- Division of Nephrology, Boston Children’s Hospital, Boston, Massachusetts
| | - Mignon I. McCulloch
- Division of Pediatric Nephrology, Red Cross Children’s Hospital, Cape Town, South Africa; and
| | - Sharon W. Su
- Division of Pediatric Nephrology, Randall Children’s Hospital, Portland, Oregon
| | - Daniel L. Hames
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital and the Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
| | - Traci A. Wolbrink
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital and the Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
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25
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McQuillan RF, Lok CE. Does peritoneal dialysis have a role in urgent-start end-stage kidney disease? Semin Dial 2018; 31:325-331. [PMID: 29676003 DOI: 10.1111/sdi.12700] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Despite its many positive attributes, peritoneal dialysis remains underutilized, particularly in the United States. Urgent-start peritoneal dialysis (PD) has been proposed as a method of increasing PD prevalence. Urgent-start PD has been shown to be safe, feasible, and effective. However, urgent-start PD is also accompanied by several multidimensional challenges. This article is intended to equip the reader with a practical sense of whether an urgent-start PD program would be appropriate in his or her own clinical context and if appropriate, what factors would be necessary for such a program to flourish. As such, we summarize latent factors, which are necessary to consider before instituting an urgent-start PD. Then, using a series of clinical vignettes, highlight the component parts of a successful urgent-start PD program and the patient population who stand to benefit most from this strategy. The discussion is then balanced by presenting limitations to consider in the urgent-start PD approach.
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Affiliation(s)
- Rory F McQuillan
- Division of Nephrology, Department of Medicine, University Health Network and The University of Toronto, Toronto, Ontario, Canada
| | - Charmaine E Lok
- Division of Nephrology, Department of Medicine, University Health Network and The University of Toronto, Toronto, Ontario, Canada
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26
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Perez JJ, Zhao B, Qureshi S, Winkelmayer WC, Erickson KF. Health Insurance and the Use of Peritoneal Dialysis in the United States. Am J Kidney Dis 2018; 71:479-487. [PMID: 29277511 PMCID: PMC6502758 DOI: 10.1053/j.ajkd.2017.09.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 09/30/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Many patients in the United States have limited or no health insurance at the time they develop end-stage renal disease (ESRD). We examined whether health insurance limitations affected the likelihood of peritoneal dialysis (PD) use. STUDY DESIGN Retrospective cohort analysis of patients from the US Renal Data System initiating dialysis therapy in 2006 through 2012. SETTING & PARTICIPANTS We identified socioeconomically similar groups of patients to examine the association between health insurance and PD use. Patients aged 60 to 64 years with "limited insurance" (defined as having Medicaid or no insurance) at ESRD onset were compared with patients aged 66 to 70 years who were dually eligible for Medicare and Medicaid at ESRD onset. PREDICTOR Type of insurance coverage at ESRD onset. OUTCOMES The likelihoods of receiving PD before dialysis month 4, when all patients qualified for Medicare due to ESRD, and of switching to PD therapy following receipt of Medicare. RESULTS After adjusting for observable patient and geographic differences, patients with limited insurance had an absolute 2.4% (95% CI, 1.1%-3.7%) lower probability of PD use by dialysis month 4 compared with patients with Medicare at ESRD onset. The association between insurance and PD use reversed when patients became Medicare eligible; patients with limited insurance had a 3-fold higher rate of switching to PD therapy between months 4 and 12 of dialysis (HR, 2.9; 95% CI, 1.8-4.6) compared with patients with Medicare at ESRD onset. LIMITATIONS Because this study was observational, there is a potential for bias from unmeasured patient-level factors. CONCLUSIONS Despite Medicare's policy of covering patients in the month that they initiate PD therapy, insurance limitations remain a barrier to PD use for many patients. Educating providers about Medicare reimbursement policy and expanding access to pre-ESRD education and training may help overcome these barriers.
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Affiliation(s)
- Jose J Perez
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston TX
| | - Bo Zhao
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston TX
| | - Samaya Qureshi
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston TX
| | - Wolfgang C Winkelmayer
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston TX
| | - Kevin F Erickson
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston TX; Center for Innovations in Quality, Effectiveness, and Safety, Baylor College of Medicine, Houston TX; Baker Institute for Public Policy, Rice University, Houston TX.
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27
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Turenne M. Rising Peritoneal Dialysis Tide May Still Leave Some Patients Behind. Am J Kidney Dis 2018; 71:455-457. [PMID: 29579417 DOI: 10.1053/j.ajkd.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/02/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Marc Turenne
- Arbor Research Collaborative for Health, Ann Arbor, MI.
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28
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Davidson I, Gallieni M, Saxena R, Dolmatch B. A Patient Centered Decision Making Dialysis Access Algorithm. J Vasc Access 2018. [DOI: 10.1177/112972980700800201] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Much controversy surrounds the establishment of proper planning, placement and management (the best practice pattern) of dialysis access. These include the dialysis type and modality selection, timing of access placement and who places the access. The lack of and the difficulty of performing randomized studies with multiple confounding factors, in an extremely heterogeneous and rapidly changing ESRD population demographics, only partly explains the dialysis access conundrum. Add to this the rapidly developing and competing technologies, the wide spectrum of the professional experience, bias and socio-economic forces to make the ESRD problems as multivariate and complex as life itself. This overview describes a dialysis access algorithm approach to the patient needing renal replacement therapy, considering long-term improved patient outcome as the ultimate objective.
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Affiliation(s)
- I. Davidson
- Division of Transplant, Department of Surgery, Parkland Memorial Hospital, University of Texas Southwestern Medical Center, Dallas - USA
| | - M. Gallieni
- Renal Unit San Paolo Hospital, University of Milan - Italy
| | - R. Saxena
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas - USA
| | - B. Dolmatch
- Division of Interventional Radiology, University of Texas Southwestern Medical Center, Dallas - USA
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29
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Jaar BG, Choi MJ. An Introduction to dialysis education: Issues, innovations and impact. Semin Dial 2018; 31:99-101. [PMID: 29509328 DOI: 10.1111/sdi.12680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Bernard G Jaar
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Nephrology Center of Maryland, Baltimore, MD, USA
| | - Michael J Choi
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Abstract
Although varying widely among different countries and geographic regions, the development of peritoneal dialysis invariably requires a well-established program. Key ingredients for the successful delivery of this therapy include adequate chronic kidney disease education, governmental or nongovernmental reimbursement, qualified physicians and nurses trained in the principles and practice of peritoneal dialysis, clinical management that incorporates an excellent and well-trained peritoneal dialysis team, a feasible and well-designed program for catheter insertion, a sound patient training and follow-up scheme, and continuous quality improvement. Some programs are enhanced by an active clinical research portfolio and other appropriate supportive systems. All of these factors are interlinked and inseparable from one another in ensuring a high-quality peritoneal dialysis program.
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31
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Abstract
Peritoneal dialysis is the most common modality for home dialysis and to ensure patients have access to dialysis at home, training programs have to ensure that the fellows attain clinical competency in the care of such patients. The limited data available however are sobering; about 10 years ago, 44% of nephrologists reported that they did not feel competent in the care of patients undergoing peritoneal dialysis. There are recognizable challenges in ensuring clinical competency of trainees that may need creative solutions. It is important for training program directors to evaluate the state of training at their institution, identify their unique barriers, and work to overcome them in the interest of ensuring that fellows are trained in all aspects of nephrology.
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Affiliation(s)
- Rajnish Mehrotra
- Harborview Medical Center and Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
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32
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Turenne M, Baker R, Pearson J, Cogan C, Mukhopadhyay P, Cope E. Payment Reform and Health Disparities: Changes in Dialysis Modality under the New Medicare Dialysis Payment System. Health Serv Res 2017; 53:1430-1457. [PMID: 28560726 DOI: 10.1111/1475-6773.12713] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the effect of the Medicare dialysis payment reform on potential disparities in the selection of peritoneal dialysis (PD) for the treatment of end-stage renal disease (ESRD). DATA SOURCES Centers for Medicare & Medicaid Services (CMS) ESRD Medical Evidence Form, Medicare claims, and other CMS data for 2008-2013. STUDY DESIGN We examined the association of patient age, race/ethnicity, urban/rural location, pre-ESRD care, comorbidities, insurance, and other factors with the selection of PD as initial dialysis modality across prereform (2008-2009), interim (2010), and postreform (2011-2013) time periods. PRINCIPAL FINDINGS Selection of PD increased among diverse patient subgroups following the payment reform. However, the lower PD selection observed with older age, black race, Hispanic ethnicity, less pre-ESRD care, and Medicaid insurance before the reform largely remained in the initial postreform years. CONCLUSIONS Despite recent growth in PD, there may be ongoing disparities in access to PD that have largely not been mitigated by the payment reform. There is potential for modifying provider financial incentives to achieve policy goals related to cost and quality of care. However, even with a substantial shift in financial incentives, separate initiatives to reduce existing disparities in care may be needed.
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Affiliation(s)
- Marc Turenne
- Arbor Research Collaborative for Health, Ann Arbor, MI
| | - Regina Baker
- Arbor Research Collaborative for Health, Ann Arbor, MI
| | | | - Chad Cogan
- Arbor Research Collaborative for Health, Ann Arbor, MI
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Rope RW, Pivert KA, Parker MG, Sozio SM, Merell SB. Education in Nephrology Fellowship: A Survey-Based Needs Assessment. J Am Soc Nephrol 2017; 28:1983-1990. [PMID: 28428332 DOI: 10.1681/asn.2016101061] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Educational needs assessments for nephrology fellowship training are limited. This study assessed fellows' perceptions of current educational needs and interest in novel modalities that may improve their educational experience and quantified educational resources used by programs and fellows. We distributed a seven-question electronic survey to all United States-based fellows receiving complimentary American Society of Nephrology (ASN) membership at the end of the 2015-2016 academic year in conjunction with the ASN Nephrology Fellows Survey. One third (320 of 863; 37%) of fellows in Accreditation Council for Graduate Medical Education-accredited positions responded. Most respondents rated overall quality of teaching in fellowship as either "good" (37%) or "excellent" (44%), and most (55%) second-year fellows felt "fully prepared" for independent practice. Common educational resources used by fellows included UpToDate, Journal of the American Society of Nephrology/Clinical Journal of the American Society of Nephrology, and Nephrology Self-Assessment Program; others-including ASN's online curricula-were used less often. Fellows indicated interest in additional instruction in several core topics, including home dialysis modalities, ultrasonography, and pathology. Respondents strongly supported interventions to improve pathology instruction and increase time for physiology and clinical review. In conclusion, current nephrology fellows perceive several gaps in training. Innovation in education and training is needed to better prepare future nephrologists for the growing challenges of kidney care.
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Affiliation(s)
- Robert W Rope
- Division of Nephrology, Stanford University School of Medicine, Stanford, California;
| | | | - Mark G Parker
- Division of Nephrology, Maine Medical Center and Tufts University School of Medicine, Portland, Maine
| | - Stephen M Sozio
- Division of Nephrology and.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Sylvia Bereknyei Merell
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California
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34
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Zhang Q, Thamer M, Kshirsagar O, Zhang Y. Impact of the End Stage Renal Disease Prospective Payment System on the Use of Peritoneal Dialysis. Kidney Int Rep 2016; 2:350-358. [PMID: 29142964 PMCID: PMC5678611 DOI: 10.1016/j.ekir.2016.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 11/30/2016] [Accepted: 12/12/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction The End Stage Renal Disease (ESRD) Prospective Payment System (PPS), implemented by the Centers for Medicare and Medicaid Services in January 2011, encouraged use of peritoneal dialysis (PD) through various financial incentives. Our goal was to determine whether PPS effectively increased PD use in incident dialysis patients. Methods Our study used the United States Renal Data System (USRDS) to identify 430,927 adult patients who initiated dialysis between 2009 and 2012. The interrupted time series method was used to evaluate the association Centers for Medicare and Medicaid Services of PPS with PD use at dialysis initiation. We further stratified by patient demographics, predialysis care, and facility chain and profit status. Results Interrupted time series analysis indicated PPS was associated with increased PD use in the 2-year period after PPS (change in slope = 0.04, P < 0.0001), although there was no immediate change in the level of PD use at the beginning of PPS (P = 0.512). Stratified analyses indicated PPS led to increased PD use across all age, race, and sex groups (P < 0.05) although marginally among females (P = 0.09). Notably, small dialysis organizations and nonprofit organizations appeared to increase use of PD faster compared to large dialysis organizations and for-profit units, respectively. Discussion Implementation of the Centers for Medicare and Medicaid Services ESRD payment reform was associated with an increased use of PD in the 2 years after PPS. Our findings highlight the role of financial incentives in changing practice patterns to increase use of a dialysis modality considered to be both more cost-effective and empowering to ESRD patients. However, even after PPS, rates of PD use remain low among the dialysis population in the USA.
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Affiliation(s)
- Qian Zhang
- Medical Technology and Practice Patterns Institute, Bethesda, Maryland, USA
| | - Mae Thamer
- Medical Technology and Practice Patterns Institute, Bethesda, Maryland, USA
| | - Onkar Kshirsagar
- Medical Technology and Practice Patterns Institute, Bethesda, Maryland, USA
| | - Yi Zhang
- Medical Technology and Practice Patterns Institute, Bethesda, Maryland, USA
- Correspondence: Yi Zhang, PhD, Medical Technology and Practice Patterns Institute (MTPPI), 5272 River Road, Suite 365, Bethesda, Maryland 20816, USA.Medical Technology and Practice Patterns Institute (MTPPI)5272 River RoadSuite 365BethesdaMaryland 20816USA
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iChoose Kidney: A Clinical Decision Aid for Kidney Transplantation Versus Dialysis Treatment. Transplantation 2016; 100:630-9. [PMID: 26714121 DOI: 10.1097/tp.0000000000001019] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Despite a significant survival advantage of kidney transplantation compared with dialysis, nearly one third of end-stage renal disease (ESRD) patients are not educated about kidney transplantation as a treatment option at the time of ESRD diagnosis. Access to individualized, evidence-based prognostic information is needed to facilitate and encourage shared decision making about the clinical implications of whether to pursue transplantation or long-term dialysis. METHODS We used a national cohort of incident ESRD patients in the US Renal Data System surveillance registry from 2005 to 2011 to develop and validate prediction models for risk of 1- and 3-year mortality among dialysis versus kidney transplantation. Using these data, we developed a mobile clinical decision aid that provides estimates of risks of death and survival on dialysis compared with kidney transplantation patients. RESULTS Factors included in the mortality risk prediction models for dialysis and transplantation included age, race/ethnicity, dialysis vintage, and comorbidities, including diabetes, hypertension, cardiovascular disease, and low albumin. Among the validation cohorts, the discriminatory ability of the model for 3-year mortality was moderate (c statistic, 0.7047; 95% confidence interval, 0.7029-0.7065 for dialysis and 0.7015; 95% confidence interval, 0.6875-0.7155 for transplant). We used these risk prediction models to develop an electronic, user-friendly, mobile (iPad, iPhone, and website) clinical decision aid called iChoose Kidney. CONCLUSIONS The use of a mobile clinical decision aid comparing individualized mortality risk estimates for dialysis versus transplantation could enhance communication between ESRD patients and their clinicians when making decisions about treatment options.
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Overcoming the Underutilisation of Peritoneal Dialysis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:431092. [PMID: 26640787 PMCID: PMC4658397 DOI: 10.1155/2015/431092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/20/2015] [Indexed: 11/23/2022]
Abstract
Peritoneal dialysis is troubled with declining utilisation as a form of renal replacement therapy in developed countries. We review key aspects of therapy evidenced to have a potential to increase its utilisation. The best evidence to repopulate PD programmes is provided for the positive impact of timely referral and systematic and motivational predialysis education: average odds ratio for instituting peritoneal dialysis versus haemodialysis was 2.6 across several retrospective studies on the impact of predialysis education. Utilisation of PD for unplanned acute dialysis starts facilitated by implantation of peritoneal catheters by interventional nephrologists may diminish the vast predominance of haemodialysis done by central venous catheters for unplanned dialysis start. Assisted peritoneal dialysis can improve accessibility of home based dialysis to elderly, frail, and dependant patients, whose quality of life on replacement therapy may benefit most from dialysis performed at home. Peritoneal dialysis providers should perform close monitoring, preventing measures, and timely prophylactic therapy in patients judged to be prone to EPS development. Each peritoneal dialysis programme should regularly monitor, report, and act on key quality indicators to manifest its ability of constant quality improvement and elevate the confidence of interested patients and financing bodies in the programme.
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Zhang L, Hawley CM, Johnson DW. Focus on peritoneal dialysis training: working to decrease peritonitis rates. Nephrol Dial Transplant 2015; 31:214-22. [PMID: 26908816 DOI: 10.1093/ndt/gfu403] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/02/2014] [Indexed: 11/12/2022] Open
Abstract
Patient training has widely been considered to be one of the most critical factors for achieving optimal peritoneal dialysis clinical outcomes, including avoidance of peritonitis. However, research in this important area has been remarkably scant to date. This article will critically review the clinical evidence underpinning PD patient training and will specifically focus on four key areas: who should provide training and how, when and where should it be performed to obtain the best results. Evidence gaps and future research directions will also be discussed.
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Affiliation(s)
- Lei Zhang
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
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Arramreddy R, Zheng S, Saxena AB, Liebman SE, Wong L. Urgent-start peritoneal dialysis: a chance for a new beginning. Am J Kidney Dis 2013; 63:390-5. [PMID: 24246221 DOI: 10.1053/j.ajkd.2013.09.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 09/23/2013] [Indexed: 11/11/2022]
Abstract
Peritoneal dialysis (PD) remains greatly underutilized in the United States despite the widespread preference of home modalities among nephrologists and patients. A hemodialysis-centric model of end-stage renal disease care has perpetuated for decades due to a complex set of factors, including late end-stage renal disease referrals and patients who present to the hospital requiring urgent renal replacement therapy. In such situations, PD rarely is a consideration and patients are dialyzed through a central venous catheter, a practice associated with high infection and mortality rates. Recently, the term urgent-start PD has gained momentum across the nephrology community and has begun to change this status quo. It allows for expedited placement of a PD catheter and initiation of PD therapy within days. Several published case reports, abstracts, and poster presentations at national meetings have documented the initial success of urgent-start PD programs. From a wide experiential base, we discuss the multifaceted issues related to urgent-start PD implementation, methods to overcome barriers to therapy, and the potential impact of this technique to change the existing dialysis paradigm.
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Affiliation(s)
- Rohini Arramreddy
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, CA; Satellite Healthcare, Inc, San Jose, CA.
| | - Sijie Zheng
- Department of Nephrology, The Permanente Medical Group, Oakland, CA
| | - Anjali B Saxena
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, CA; Department of Nephrology, Santa Clara Valley Medical Center, San Jose, CA
| | - Scott E Liebman
- Department of Nephrology, University of Rochester Medical Center, Rochester, NY
| | - Leslie Wong
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, CA; Satellite Healthcare, Inc, San Jose, CA
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Li PKT, Chow KM. Peritoneal Dialysis–First Policy Made Successful: Perspectives and Actions. Am J Kidney Dis 2013; 62:993-1005. [DOI: 10.1053/j.ajkd.2013.03.038] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 03/19/2013] [Indexed: 12/31/2022]
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Golper TA, Mehrotra R, Schreiber MS. Is Dorothy correct? The role of patient education in promoting home dialysis. Semin Dial 2013; 26:138-42. [PMID: 23520987 DOI: 10.1111/sdi.12086] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The major payer of dialysis services in the United States, Medicare, has established incentives to encourage the use of home dialysis. However, this modality remains underutilized. We think that a major cause of this situation is ineffective education of the prospective dialysis population regarding the choices of kidney replacement modalities. We discuss the value of patient education and the consequences of failing to educate prospective dialysis patients. We then explore approaches to achieve patient education goals and the physician's and education team's roles in the development of an individual patient's life plan.
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Affiliation(s)
- Thomas A Golper
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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Affiliation(s)
- Thomas A Golper
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
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Jhaveri KD, Sparks MA, Shah HH. Novel educational approaches to enhance learning and interest in nephrology. Adv Chronic Kidney Dis 2013; 20:336-46. [PMID: 23809286 DOI: 10.1053/j.ackd.2013.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 03/16/2013] [Accepted: 03/26/2013] [Indexed: 11/11/2022]
Abstract
The number of U.S. medical graduates pursuing careers in nephrology has declined over the last several years. Some of the proposed reasons for this declining interest include difficult-to-understand or unstimulating kidney pathophysiology courses in medical school; disheartening inpatient elective experiences; and few opportunities to experience the other aspects of nephrology careers such as outpatient nephrology clinics, outpatient dialysis, and kidney transplantation. Novel and alternative educational approaches should be considered by the nephrology training community to enhance the understanding of nephrology from medical school to fellowship training. Newer teaching methods and styles should also be incorporated to adapt to today's learner. These innovative educational approaches may not only increase interest in nephrology careers, but they may also enhance and maintain interest during nephrology fellowship. In this article, we will review several educational approaches that may enhance teaching and learning in nephrology.
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Castledine CI, Gilg JA, Rogers C, Ben-Shlomo Y, Caskey FJ. Renal centre characteristics and physician practice patterns associated with home dialysis use. Nephrol Dial Transplant 2013; 28:2169-80. [PMID: 23737483 DOI: 10.1093/ndt/gft196] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is a wide variation in home dialysis use (peritoneal dialysis and home haemodialysis) between renal centres. This study identifies which centre characteristics and practice patterns are associated with home dialysis use. METHODS An observational study of all UK patients starting renal replacement therapy (RRT) in 2007-2008 using patient characteristics from the UK Renal Registry (UKRR) and renal centre characteristics ascertained from a national survey. Multilevel logistic regression was used to examine the association between patient and centre characteristics and home dialysis uptake. RESULTS Twenty-six per cent of 11 913 patients used home dialysis and survey responses were available from every renal centre. After taking into account patient factors, several centre factors were associated with a higher probability of home dialysis: physicians aspiring to a higher 'ideal' peritoneal dialysis rate (odds ratio, OR 1.21, 95% CI 1.06-1.37, P = 0.003 per 10% increase in 'ideal' percentage), early use of peritoneal dialysis (PD, OR 1.52, 95% CI 1.18-1.95, P < 0.001), use of home visits to educate patients pre-dialysis (OR 1.39, 95% CI 1.05-1.83, P = 0.02) and to provide trouble-shooting advice for existing home dialysis patients (OR 1.63, 95% CI 1.11-2.42, P = 0.01). Using videos/DVDs as part of the pre-dialysis education programme was associated with a lower probability of home dialysis, but this was correlated with lower levels of physician enthusiasm (r = -0.48, P < 0.001). After adjustment for this, the association disappeared (OR 0.77, 95% CI 0.55-1.07, P = 0.1). CONCLUSIONS Home dialysis use is associated with modifiable centre factors as well as individual patient characteristics.
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Wadhwa NK, Messina CR, Hebah NM. Does Current Nephrology Fellowship Training Affect Uti-lization of Peritoneal Dialysis in the United States? ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojneph.2013.32019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Young BA, Chan C, Blagg C, Lockridge R, Golper T, Finkelstein F, Shaffer R, Mehrotra R. How to overcome barriers and establish a successful home HD program. Clin J Am Soc Nephrol 2012; 7:2023-32. [PMID: 23037981 PMCID: PMC3513750 DOI: 10.2215/cjn.07080712] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 08/18/2012] [Indexed: 11/23/2022]
Abstract
Home hemodialysis (HD) is an underused dialysis modality in the United States, even though it provides an efficient and probably cost-effective way to provide more frequent or longer dialysis. With the advent of newer home HD systems that are easier for patients to learn, use, and maintain, patient and provider interest in home HD is increasing. Although barriers for providers are similar to those for peritoneal dialysis, home HD requires more extensive patient training, nursing education, and infrastructure support in order to maintain a successful program. In addition, because many physicians and patients do not have experience with home HD, reluctance to start home HD programs is widespread. This in-depth review describes barriers to home HD, focusing on patients, individual physicians and practices, and dialysis facilities, and offers suggestions for how to overcome these barriers and establish a successful home HD program.
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Affiliation(s)
- Bessie A Young
- Veterans Affairs Puget Sound Health Care System, Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington 98108, USA.
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Woodrow G. What are the factors underlying the variation in the use of peritoneal dialysis? Nephrol Dial Transplant 2012; 28:501-4. [PMID: 22904100 DOI: 10.1093/ndt/gfs376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jain AK, Blake P, Cordy P, Garg AX. Global trends in rates of peritoneal dialysis. J Am Soc Nephrol 2012; 23:533-44. [PMID: 22302194 DOI: 10.1681/asn.2011060607] [Citation(s) in RCA: 361] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Although there is a perception that the use of peritoneal dialysis is declining worldwide, compilations of global data are unavailable to test this hypothesis. We assessed longitudinal trends in the use of peritoneal dialysis from 1997 to 2008 in 130 countries. The preferred data sources were renal registries, followed by nephrology societies, health ministries, academic centers, national experts, and industry affiliates. In 2008, there were approximately 196,000 peritoneal dialysis patients worldwide, representing 11% of the dialysis population. In total, 59% were treated in developing countries and 41% in developed countries. Over 12 years, the number of peritoneal dialysis patients increased in developing countries by 24.9 patients per million population and in developed countries by 21.8 per million population. The proportion of all dialysis patients treated with peritoneal dialysis did not change in developing countries but significantly declined in developed countries by 5.3%. The use of automated peritoneal dialysis increased by 14.5% in developing countries and by 30.3% in developed countries. In summary, the number of patients treated with peritoneal dialysis rose worldwide from 1997 to 2008, with a 2.5-fold increase in the prevalence of peritoneal dialysis patients in developing countries. The proportion of all dialysis patients treated with this modality continues to decline in developed countries.
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Affiliation(s)
- Arsh K Jain
- Division of Nephrology, University of Western Ontario, London, Canada.
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Devlin A, Waikar SS, Solomon DH, Lu B, Shaykevich T, Alarcón GS, Winkelmayer WC, Costenbader KH. Variation in initial kidney replacement therapy for end-stage renal disease due to lupus nephritis in the United States. Arthritis Care Res (Hoboken) 2012; 63:1642-53. [PMID: 22058067 DOI: 10.1002/acr.20607] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Little is known about the patterns of use of initial kidney replacement therapies among patients with lupus nephritis (LN) end-stage renal disease (ESRD). We aimed to identify sociodemographic and clinical factors associated with variation in initial kidney replacement therapies among LN ESRD patients. METHODS Patients with incident LN ESRD (1995-2006) were identified in the US Renal Data System. Age, sex, race, ethnicity, medical insurance, employment status, residential region, clinical factors, and comorbidities were considered as potential predictors of ESRD treatment choice, i.e., peritoneal dialysis (PD), hemodialysis (HD), or preemptive kidney transplantation in age-adjusted and multivariable-adjusted logistic regression analyses. RESULTS Of the 11,317 individuals with incident LN ESRD, 82.0% initiated HD, 12.2% initiated PD, and 2.8% underwent preemptive kidney transplantation. Receiving initial PD was significantly associated with earlier calendar year, female sex, higher albumin and hemoglobin levels, and lower serum creatinine levels. African Americans (versus whites), Medicaid beneficiaries and those with no health insurance (versus private insurance), and those unemployed (versus employed) had significantly reduced PD initiation. Comorbidities including congestive heart failure, peripheral vascular disease, and the inability to ambulate were also associated with decreased PD. Many sociodemographic and clinical factors favoring PD were associated with preemptive kidney transplant (versus dialysis) as well. CONCLUSION Few patients with LN ESRD receive initial PD or preemptive kidney transplantation. Race, ethnicity, employment, and medical insurance type are strongly associated with initial kidney replacement therapy choice. Future studies need to investigate the appropriateness of sociodemographic and clinical variation and the comparative effectiveness of kidney replacement therapies for LN ESRD.
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Affiliation(s)
- Amy Devlin
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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