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Sakurada T, Miyazaki M, Nakayama M, Ito Y. Peritoneal dialysis-related infections in elderly patients. Clin Exp Nephrol 2024:10.1007/s10157-024-02531-5. [PMID: 38914913 DOI: 10.1007/s10157-024-02531-5] [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: 05/22/2024] [Accepted: 06/16/2024] [Indexed: 06/26/2024]
Abstract
This review outlines the epidemiology, characteristics, risk factors, and prognosis of peritoneal dialysis (PD)-related peritonitis, PD catheter-related infections, and the effects of assisted PD in elderly patients from the Japanese perspective. Based on the literature, the incidence of peritonitis is likely to be higher in elderly patients than in younger patients. The most frequent causative bacteria in elderly patients are Gram-positive bacteria, as in adult PD patients, most commonly due to transcatheter infection. However, elderly patients may have difficulty recognizing cloudy drainage fluid due to decreased visual acuity. Hypokalemia, the use of gastric acid suppressants, prophylactic antibiotic use before endoscopy, biocompatible fluids and hypoalbuminemia considered modifiable risk factors for peritonitis. However, the mechanism by which treatment of hypokalemia prevents peritonitis is unknown. Currently, the relationship between gastric acid suppression therapy and peritonitis in elderly patients is debatable, with no evidence to strongly recommend uniform discontinuation of gastric acid suppression therapy. Exit-site infection (ESI) is a major risk factor for the development of peritonitis, and appropriate prevention and management of ESI may reduce infection-related hospitalizations in PD patients. Currently, no randomized, controlled trials have verified the effectiveness of antibiotic application for ESI in Japan, but results from other countries are awaited. In assisted PD, it is extremely important that family members, caregivers, and nurses who support the procedure receive sufficient education and training from medical professionals familiar with PD. Early detection and treatment of PD-related infections are required because the risk of death increases in elderly patients.
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Affiliation(s)
- Tsutomu Sakurada
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, 216-8511, Japan.
| | | | - Masaaki Nakayama
- St Luke's International University, Visiting Researcher, Tokyo, Japan
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2
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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.
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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
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3
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Wong SN, Turnbull L, Saunders S, Er L, Bevilacqua MU, Levin A, Singh RS. Evaluation and outcomes of a 5-year assisted peritoneal dialysis program. Perit Dial Int 2024; 44:177-184. [PMID: 36749175 DOI: 10.1177/08968608221149546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In 2016, Peritoneal Dialysis Assist (PDA) was implemented in British Columbia, Canada, as a pilot program to allow patients with physical, cognitive and social impairments to access an independent dialysis modality. This is a presentation of the usage and 5-year clinical outcomes of our provincial assisted peritoneal dialysis (PD) program. METHODS Patients who utilised long-term or respite PDA services in British Columbia, Canada, from 2016 to 2021 were included in this program evaluation. Incident and prevalent patient numbers were characterised annually as well as indications for PDA and patient demographics both annually and over time. Outcomes of interest included death, transfer to haemodialysis, transplantation and cessation of the PDA program but retention on PD. RESULTS Three hundred twenty-two total patients received services through the PDA program. The percentage of PD patients supported by long-term PDA service has grown to 11.2% in the most recent year. Patients spend a median of 13.6 (95% CI: 11.0, 16.1) months on long-term PDA, prolonging overall patient duration on PD by a little over a year. Of the patients who exited the long-term PDA program, 73 (37.4%) were able to utilise the service until they died. CONCLUSION PDA is an accessible, patient-centric service with clear and standardised referral criteria. Through the implementation of a local PDA program, patients have accessed PD and may have extended their PD life span, through avoidance of in-centre haemodialysis, by over 13 months during this 5-year study period. A significant proportion of patients on long-term PDA were able to use their preferred kidney replacement modality at home until they reached end of life.
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Affiliation(s)
- Shannon N Wong
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Linda Turnbull
- British Columbia Provincial Renal Agency, Vancouver, BC, Canada
| | | | - Lee Er
- British Columbia Provincial Renal Agency, Vancouver, BC, Canada
| | - Micheli U Bevilacqua
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Provincial Renal Agency, Vancouver, BC, Canada
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Provincial Renal Agency, Vancouver, BC, Canada
| | - Rajinder S Singh
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Jiang X, Wang Y, Xiao A, Feng S. Patients undergoing assisted peritoneal dialysis to show a better technique survival: A competing risk analysis. Int J Clin Pract 2021; 75:e14192. [PMID: 33792114 DOI: 10.1111/ijcp.14192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/27/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS To compare patient mortality and technique survival between patients undergoing assisted peritoneal dialysis (aPD) and self-care peritoneal dialysis (sPD). METHODS Patients who underwent peritoneal dialysis (PD) at the dialysis center of Second Affiliated Hospital of Soochow University from January 1, 2012 to December 31, 2016, were included and followed to December 31, 2019. Subjects were divided into aPD and sPD groups according to whether the patient could independently complete the PD procedure. Differences in mortality and technique failure rates were compared using competing risk analysis. RESULTS A total of 384 patients were included in this study, with 274 patients in the sPD group and 110 patients in the aPD group. The multivariate competing risk regression analysis revealed that age (HR 1.03,95%CI 1.01-1.05, P < .001), aPD (HR 1.84,95%CI 1.10-3.08, P = .02), diabetes (HR 1.51, 95%CI 1.00-2.30, P = .05), residual renal function (HR 0.89, 95%CI 0.82-0.97, P = .005) and serum albumin level (HR 0.92, 95% CI 0.89-0.96, P < .001) were the independent risk factors for mortality. Besides, technique failure in aPD patients was lower than in the sPD group (HR 0.85, 95% CI 0.68-0.97, P = .03). CONCLUSION These results found that aPD patients had higher mortality rates but lower technique failure rates than sPD patients. Higher mortality in aPD is probably related to the negative selection of the more comorbid patients. .
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Affiliation(s)
- Xiaomei Jiang
- Department of Nursing, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yun Wang
- Department of Nursing, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Aihua Xiao
- Department of Nursing, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Sheng Feng
- Department of Nephrology, Second Affiliated Hospital of Soochow University, Suzhou, China
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Wu H, Ye H, Huang R, Yi C, Wu J, Yu X, Yang X. Incidence and risk factors of peritoneal dialysis-related peritonitis in elderly patients: A retrospective clinical study. Perit Dial Int 2021; 40:26-33. [PMID: 32063144 DOI: 10.1177/0896860819879868] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This study was to analyze the incidence, risk factors, and clinical outcomes of peritonitis in elderly continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS Incident patients undergone CAPD from 1 January 2006 to 30 June 2015 in our center were enrolled and divided into aged < 65 years and ≥ 65 years groups. Risk factors were evaluated using a logistic regression model, and outcome comparison was evaluated using a Cox proportional model. RESULTS Among 1953 patients, 111(33.2%) in elderly (n = 334) and 470 (29.0%) in younger (n = 1619) developed at least one episode of peritonitis. Comparing with younger patients, elderly ones had a higher peritonitis rate (0.203 vs. 0.145 episodes/patient-year, p < 0.05). The multivariate Cox regression showed that advanced age (hazard ratio (HR) = 1.06, 95% confidence interval (CI) = 1.01-1.11, p = 0.015), assistant-assisted peritoneal dialysis (PD; HR = 2.64, 95% CI = 1.23-5.64, p = 0.012), higher body mass index (BMI; HR = 1.11, 95% CI = 1.02-1.20, p = 0.010), and low serum albumin level (HR = 0.94, 95% CI = 0.90-0.98, p = 0.004) were associated with increased peritonitis risk in elderly patients. Compared with younger ones with peritonitis, elderly patients had an approximately fourfold increased risk of peritonitis-related mortality (odd ratio (OR) = 3.57, 95% CI = 1.38-9.28, p = 0.009). During the cohort, peritonitis was the risk factor associated with technique failure (HR = 3.19, 95% CI = 2.33-4.39, p < 0.001) in younger patient but not in the elderly population (HR = 1.82, 95% CI = 0.84-3.94, p = 0.132). CONCLUSIONS Elderly PD patients had higher prevalence for peritonitis and peritonitis-related mortality. Advanced age, assistant-assisted PD, a higher BMI, and lower serum albumin level were independently associated with the first episode of peritonitis in elderly patients. However, peritonitis was not the predictor of death-censored technique failure in elderly ones.
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Affiliation(s)
- Haishan Wu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University; Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University; Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Rong Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University; Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University; Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Juan Wu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University; Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University; Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University; Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
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Boyer A, Lanot A, Lambie M, Guillouet S, Lobbedez T, Béchade C. Trends in assisted peritoneal dialysis over the last decade: a cohort study from the French Peritoneal Dialysis Registry. Clin Kidney J 2021; 13:1003-1011. [PMID: 33391743 PMCID: PMC7769513 DOI: 10.1093/ckj/sfaa051] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/26/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is limited information available on the use of assisted peritoneal dialysis (PD) over time and the impact of economic incentives on its utilization. The aim of this study was to describe the trends in assisted PD utilization and the type of assistance provided. We wanted to estimate if an economic incentive implemented in 2011 in France was associated with an increase in the utilization of nurse-assisted PD. METHODS This retrospective, multicentre study, based on data from the French Language Peritoneal Dialysis Registry, analysed 11 987 patients who initiated PD in France between 1 January 2006 and 31 December 2015. Adjusted Cox regression with robust variance was used to examine the initiation of assisted PD, both nurse-assisted and family-assisted, accounting for the nonlinear impact of the PD starting time. RESULTS There were 6149 (51%) incident patients on assisted PD, 5052 (82%) on nurse-assisted PD and 1097 (18%) on family-assisted PD over the study period. In the adjusted analysis, calendar time was associated with the assisted PD rate: it declined from 2008 until 2013 before flattening out and then it increased after 2014. Nurse-assisted PD utilization increased significantly after 2012, whereas family-assisted PD utilization decreased linearly over time (prevalence ratio = 0.94, 95% confidence interval 0.92-0.97). CONCLUSIONS The assisted PD rate decreased until 2013, mainly because of a decline in family-assisted PD. The uptake in nurse-assisted PD observed from 2013 reflects the effect of an economic incentive adopted in late 2011 to increase PD utilization.
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Affiliation(s)
- Annabel Boyer
- Centre Universitaire des Maladies Rénales, CHU de Caen, 14 033 Caen Cedex 9, France.,U1086, INSERM-ANTICIPE-Centre, Régional de Lutte contre, le Cancer, François Baclesse, Caen, France
| | - Antoine Lanot
- Centre Universitaire des Maladies Rénales, CHU de Caen, 14 033 Caen Cedex 9, France.,U1086, INSERM-ANTICIPE-Centre, Régional de Lutte contre, le Cancer, François Baclesse, Caen, France.,Normandie Université, Unicaen, UFR, de médecine, 2 rue des Rochambelles, 14032 Caen Cedex, France
| | - Mark Lambie
- Renal Unit, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.,Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Sonia Guillouet
- Centre Universitaire des Maladies Rénales, CHU de Caen, 14 033 Caen Cedex 9, France.,U1086, INSERM-ANTICIPE-Centre, Régional de Lutte contre, le Cancer, François Baclesse, Caen, France.,Normandie Université, Unicaen, UFR, de médecine, 2 rue des Rochambelles, 14032 Caen Cedex, France
| | - Thierry Lobbedez
- Centre Universitaire des Maladies Rénales, CHU de Caen, 14 033 Caen Cedex 9, France.,U1086, INSERM-ANTICIPE-Centre, Régional de Lutte contre, le Cancer, François Baclesse, Caen, France.,Normandie Université, Unicaen, UFR, de médecine, 2 rue des Rochambelles, 14032 Caen Cedex, France
| | - Clémence Béchade
- Centre Universitaire des Maladies Rénales, CHU de Caen, 14 033 Caen Cedex 9, France.,U1086, INSERM-ANTICIPE-Centre, Régional de Lutte contre, le Cancer, François Baclesse, Caen, France.,Normandie Université, Unicaen, UFR, de médecine, 2 rue des Rochambelles, 14032 Caen Cedex, France
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Rajora N, Shastri S, Pirwani G, Saxena R. How To Build a Successful Urgent-Start Peritoneal Dialysis Program. ACTA ACUST UNITED AC 2020; 1:1165-1177. [DOI: 10.34067/kid.0002392020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [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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8
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Hofmeister M, Klarenbach S, Soril L, Scott-Douglas N, Clement F. A Systematic Review and Jurisdictional Scan of the Evidence Characterizing and Evaluating Assisted Peritoneal Dialysis Models. Clin J Am Soc Nephrol 2020; 15:511-520. [PMID: 32188636 PMCID: PMC7133129 DOI: 10.2215/cjn.11951019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/20/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Compared with hemodialysis, home peritoneal dialysis alleviates the burden of travel, facilitates independence, and is less costly. Physical, cognitive, or psychosocial factors may preclude peritoneal dialysis in otherwise eligible patients. Assisted peritoneal dialysis, where trained personnel assist with home peritoneal dialysis, may be an option, but the optimal model is unknown. The objective of this work is to characterize existing assisted peritoneal dialysis models and synthesize clinical outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A systematic review of MEDLINE, Cochrane Central Register of Controlled Trails, Cochrane Database of Systematic Reviews, Embase, PsycINFO, and CINAHL was conducted (search dates: January 1995-September 2018). A focused gray literature search was also completed, limited to developed nations. Included studies focused on home-based assisted peritoneal dialysis; studies with the assist provided exclusively by unpaid family caregivers were excluded. All outcomes were narratively synthesized; quantitative outcomes were graphically depicted. RESULTS We included 34 studies, totaling 46,597 patients, with assisted peritoneal dialysis programs identified in 20 jurisdictions. Two categories emerged for models of assisted peritoneal dialysis on the basis of type of assistance: health care and non-health care professional assistance. Reported outcomes were heterogeneous, ranging from patient-level outcomes of survival, to resource use and transfer to hemodialysis; however, the comparative effect of assisted peritoneal dialysis was unclear. In two qualitative studies examining the patient experience, the maintenance of independence was identified as an important theme. CONCLUSIONS Reported outcomes and quality were heterogeneous, and relative efficacy of assisted peritoneal dialysis could not be determined from included studies. Although the patient voice was under-represented, suggestions to improve assisted peritoneal dialysis included using a person-centered model of care, ensuring continuity of nurses providing the peritoneal dialysis assist, and measures to support patient independence. Although attractive elements of assisted peritoneal dialysis are identified, further evidence is needed to connect assisted peritoneal dialysis outcomes with programmatic features and their associated funding models.
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Affiliation(s)
- Mark Hofmeister
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Scott Klarenbach
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lesley Soril
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | | | - Fiona Clement
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; .,Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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9
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Finkelstein FO, Afolalu B, Wuerth D, Finkelstein SH. The Elderly Patient on Capd: Helping Patients Cope with Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080802800504] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Fredric O. Finkelstein
- Hospital of St. Raphael, Renal Research Institute, Yale University, New Haven, Connecticut, USA
| | - Bayode Afolalu
- Hospital of St. Raphael, Renal Research Institute, Yale University, New Haven, Connecticut, USA
| | - Diane Wuerth
- Hospital of St. Raphael, Renal Research Institute, Yale University, New Haven, Connecticut, USA
| | - Susan H. Finkelstein
- Hospital of St. Raphael, Renal Research Institute, Yale University, New Haven, Connecticut, USA
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10
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Oliver MJ, Salenger P. Making Assisted Peritoneal Dialysis a Reality in the United States: A Canadian and American Viewpoint. Clin J Am Soc Nephrol 2019; 15:566-568. [PMID: 31852687 PMCID: PMC7133130 DOI: 10.2215/cjn.11800919] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Matthew J Oliver
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; .,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; and
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11
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Guillouët S, Lobbedez T, Lanot A, Verger C, Ficheux M, Béchade C. Factors associated with nurse assistance among peritoneal dialysis patients: a cohort study from the French Language Peritoneal Dialysis Registry. Nephrol Dial Transplant 2018; 33:1446-1452. [PMID: 29294042 DOI: 10.1093/ndt/gfx338] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 11/09/2017] [Indexed: 11/13/2022] Open
Abstract
Background No information is available regarding nurse-assisted peritoneal dialysis (PD) in non-elderly subjects. This study was carried out to estimate the rate of nurse-assisted PD among non-elderly patients and to assess which individual and centre factors were associated with nurse-assisted PD. The other objective was to estimate the magnitude of the centre effect on the utilization of nurse-assisted PD using hierarchical modelling. Methods This was a retrospective study based on data from the French Language Peritoneal Dialysis Registry. Patients incident on PD > 18 and < 65 years of age were included. Results There were 2269 incidents of PD initiation between January 2008 and December 2012 in 127 PD centres with 114 (5%) on family-assisted PD and 272 (12%) on nurse-assisted PD. At the individual level, compared with autonomous patients, nurse assistance was associated with age {odds ratio [OR] 1.79 [95% confidence interval (CI) 1.51-2.13]}, gender [OR 0.47 (95% CI 0.35-0.64)], comorbidities and underlying nephropathy. There was significant heterogeneity between centres in the nurse assistance utilization (variance of random effect 0.12). At the centre level, the type of centre, centre experience, centre organization and private nurse density were not associated with nurse-assisted PD. Conclusions The rate of nurse-assisted PD among non-elderly patients was 12%. There was a significant centre effect in the utilization of nurse assistance that was not explained by the centres' characteristics. Nurse-assisted PD utilization in non-elderly patients is associated with patient characteristics and also with centre practices.
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Affiliation(s)
- Sonia Guillouët
- Service de Néphrologie, CHU de Caen, Caen Cedex 9, France.,Registre de Dialyse Péritonéale de Langue Française, Pontoise, France
| | - Thierry Lobbedez
- Service de Néphrologie, CHU de Caen, Caen Cedex 9, France.,Registre de Dialyse Péritonéale de Langue Française, Pontoise, France.,Université Caen Normandie-UFR de Médecine (Medical School), Caen Cedex 5, France
| | - Antoine Lanot
- Service de Néphrologie, CHU de Caen, Caen Cedex 9, France.,Université Caen Normandie-UFR de Médecine (Medical School), Caen Cedex 5, France
| | - Christian Verger
- Registre de Dialyse Péritonéale de Langue Française, Pontoise, France
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Javaid MM, Lee E, Khan BA, Subramanian S. Description of an Urgent-Start Peritoneal Dialysis Program in Singapore. Perit Dial Int 2017; 37:500-502. [DOI: 10.3747/pdi.2016.00308] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Muhammad M. Javaid
- Division of Nephrology University Medicine Cluster, National University Hospital Singapore
- Yong Loo Lin School of Medicine National University of Singapore, Singapore
| | - Evan Lee
- Division of Nephrology University Medicine Cluster, National University Hospital Singapore
- Yong Loo Lin School of Medicine National University of Singapore, Singapore
| | - Behram A. Khan
- Division of Nephrology University Medicine Cluster, National University Hospital Singapore
- Yong Loo Lin School of Medicine National University of Singapore, Singapore
| | - Srinivas Subramanian
- Division of Nephrology University Medicine Cluster, National University Hospital Singapore
- Yong Loo Lin School of Medicine National University of Singapore, Singapore
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13
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Béchade C, Lobbedez T, Ivarsen P, Povlsen JV. Assisted Peritoneal Dialysis for Older People with End-Stage Renal Disease: The French and Danish Experience. Perit Dial Int 2016; 35:663-6. [PMID: 26702010 DOI: 10.3747/pdi.2014.00344] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Older people are the largest and fastest growing group of patients with end-stage renal disease (ESRD), and, due to advanced age and a heavy burden of comorbidities, they are usually not candidates for renal transplantation or home-based dialysis treatment. Some of the barriers for home treatment are non-modifiable, but the majority of physical disabilities and psychosocial problems can be overcome provided that assistance is offered to the patients at home.In the present review, we describe the programs for assisted peritoneal dialysis (PD) in France and Denmark, respectively. In both nations, assisted PD is totally publicly funded, and the cost of assisted PD is comparable to the cost of in-center HD. Assisted continuous ambulatory PD (aCAPD) is the preferred modality in France whereas assisted automated PD (aAPD) is the preferred modality in Denmark. Assistants are professional nurses or healthcare technicians briefly educated by expert PD nurses from the dialysis unit.The establishment of a program for assisted PD may increase the number of patients actually treated with PD and may reduce the risk of PD technique failure and prolong PD duration. Compared with autonomous PD patients, patients on assisted PD may have shorter patient survival and peritonitis-free survival indicating that, besides advanced age and the burden of comorbidities, dependency on help may be an independent risk factor for poorer outcome.Assisted PD is an evolving dialysis modality, and may in the future prove to be a feasible complementary alternative to in-center hemodialysis (HD) for the growing group of dependent older patients with ESRD.
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Affiliation(s)
| | | | - Per Ivarsen
- Department of Renal Medicine C, Aarhus University Hospital, Aarhus, Denmark
| | - Johan V Povlsen
- Department of Renal Medicine C, Aarhus University Hospital, Aarhus, Denmark
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Povlsen JV, Sørensen AB, Ivarsen P. Unplanned Start on Peritoneal Dialysis Right after PD Catheter Implantation for Older People with End-Stage Renal Disease. Perit Dial Int 2016; 35:622-4. [PMID: 26702001 DOI: 10.3747/pdi.2014.00347] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Unplanned start on dialysis remains a major problem for the dialysis community worldwide. Late-referred patients with end-stage renal disease (ESRD) and urgent need for dialysis are overrepresented among older people. These patients are particularly likely to be started on in-center hemodialysis (HD), with a temporary vascular access known to be associated with excess mortality and increased risks of potentially lethal complications such as bacteremia and central venous thrombosis or stenosis.The present paper describes in detail our program for unplanned start on automated peritoneal dialysis (APD) right after PD catheter implantation and summarizes our experiences with the program so far. Compared with planned start on PD after at least 2 weeks of break-in between PD catheter implantation and initiation of dialysis, unplanned start may be associated with a slight increased risk of mechanical complications but apparently no detrimental effect on mortality, peritonitis-free survival, or PD technique survival.In our opinion and experience, the risk of serious complications associated with the implantation and immediate use of a PD catheter is less than the risk of complications associated with unplanned start on HD with a temporary central venous catheter (CVC). Unplanned start on APD is a gentle, safe, and feasible alternative to unplanned start on HD with a temporary CVC that is also valid for the late-referred older patient with ESRD and urgent need for dialysis.
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Affiliation(s)
- Johan V Povlsen
- Dept. Renal Medicine C, Aarhus University Hospital, Aarhus, Denmark
| | | | - Per Ivarsen
- Dept. Renal Medicine C, Aarhus University Hospital, Aarhus, Denmark
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Brown EA, Wilkie M. Assisted Peritoneal Dialysis as an Alternative to In-Center Hemodialysis. Clin J Am Soc Nephrol 2016; 11:1522-1524. [PMID: 27464839 PMCID: PMC5012478 DOI: 10.2215/cjn.07040716] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Edwina A. Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom; and
| | - Martin Wilkie
- Renal Department, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
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Oliver MJ, Al-Jaishi AA, Dixon SN, Perl J, Jain AK, Lavoie SD, Nash DM, Paterson JM, Lok CE, Quinn RR. Hospitalization Rates for Patients on Assisted Peritoneal Dialysis Compared with In-Center Hemodialysis. Clin J Am Soc Nephrol 2016; 11:1606-1614. [PMID: 27464838 PMCID: PMC5012487 DOI: 10.2215/cjn.10130915] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 05/21/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Assisted peritoneal dialysis is a treatment option for individuals with barriers to self-care who wish to receive home dialysis, but previous research suggests that this treatment modality is associated with a higher rate of hospitalization. The objective of our study was to determine whether assisted peritoneal dialysis has a different rate of hospital days compared to in-center hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a multicenter, retrospective cohort study by linking a quality assurance dataset to administrative health data in Ontario, Canada. Subjects were accrued between January 1, 2004 and July 9, 2013. Individuals were grouped into assisted peritoneal dialysis (family or home care assisted) or in-center hemodialysis on the basis of their first outpatient dialysis modality. Inverse probability of treatment weighting using a propensity score was used to create a sample in which the baseline covariates were well balanced. RESULTS The study included 872 patients in the in-center hemodialysis group and 203 patients in the assisted peritoneal dialysis group. Using an intention to treat approach, patients on assisted peritoneal dialysis had a similar hospitalization rate of 11.1 d/yr (95% confidence interval, 9.4 to 13.0) compared with 12.9 d/yr (95% confidence interval, 10.3 to 16.1) in the hemodialysis group (P=0.19). Patients on assisted peritoneal dialysis were more likely to be hospitalized for dialysis-related reasons (admitted for 2.4 d/yr [95% confidence interval, 1.8 to 3.2] compared with 1.6 d/yr [95% confidence interval, 1.1 to 2.3] in the hemodialysis group; P=0.04). This difference was partly explained by more hospital days because of peritonitis. Modality switching was associated with high rates of hospital days per year. CONCLUSIONS Assisted peritoneal dialysis was associated with similar rates of all-cause hospitalization compared with in-center hemodialysis. Patients on assisted peritoneal dialysis who experienced peritonitis and technique failure had high rates of hospitalization.
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Affiliation(s)
- Matthew J. Oliver
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Nephrology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Ahmed A. Al-Jaishi
- Kidney, Dialysis and Transplantation Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Stephanie N. Dixon
- Kidney, Dialysis and Transplantation Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Jeffrey Perl
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Nephrology, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Arsh K. Jain
- Kidney, Dialysis and Transplantation Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Division of Nephrology, London Health Sciences Center, London, Ontario, Canada
| | - Susan D. Lavoie
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Danielle M. Nash
- Kidney, Dialysis and Transplantation Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Charmaine E. Lok
- Division of Nephrology, University Health Network–Toronto General Hospital, Toronto, Ontario, Canada; and
| | - Robert R. Quinn
- Departments of Medicine and
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Iyasere OU, Brown EA, Johansson L, Huson L, Smee J, Maxwell AP, Farrington K, Davenport A. Quality of Life and Physical Function in Older Patients on Dialysis: A Comparison of Assisted Peritoneal Dialysis with Hemodialysis. Clin J Am Soc Nephrol 2015; 11:423-30. [PMID: 26712808 DOI: 10.2215/cjn.01050115] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 11/18/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES In-center hemodialysis (HD) is often the default dialysis modality for older patients. Few centers use assisted peritoneal dialysis (PD), which enables treatment at home. This observational study compared quality of life (QoL) and physical function between older patients on assisted PD and HD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Patients on assisted PD who were >60 years old and on dialysis for >3 months were recruited and matched to patients on HD (needing hospital transport) by age, sex, diabetes, dialysis vintage, ethnicity, and index of deprivation. Frailty was assessed using the Clinical Frailty Scale. QoL assessments included Hospital Anxiety and Depression Scale (HADS), Short Form-12, Palliative Outcomes Symptom Scale (renal), Illness Intrusiveness Rating Scale, and Renal Treatment Satisfaction Questionnaire (RTSQ). Physical function was evaluated by Barthel Score and timed up and go test. RESULTS In total, 251 patients (129 PD and 122 HD) were recruited. In unadjusted analysis, patients on assisted PD had a higher prevalence of possible depression (HADS>8; PD=38.8%; HD=23.8%; P=0.05) and higher HADS depression score (median: PD=6; HD=5; P=0.05) but higher RTSQ scores (median: PD=55; HD=51; P<0.01). In a generalized linear regression model adjusting for age, sex, comorbidity, dialysis vintage, and frailty, assisted PD continued to be associated with higher RTSQ scores (P=0.04) but not with other QoL measures. CONCLUSIONS There are no differences in measures of QoL and physical function between older patients on assisted PD and comparable patients on HD, except for treatment satisfaction, which is higher in patients on PD. Assisted PD should be considered as an alternative to HD for older patients, allowing them to make their preferred choices.
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Affiliation(s)
- Osasuyi U Iyasere
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom;
| | - Lina Johansson
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Les Huson
- Centre for Pharmacology and Therapeutics, Division of Experimental Medicine, Imperial College London, London, United Kingdom
| | - Joanna Smee
- Cardiovascular and Renal Research Support Unit, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Alexander P Maxwell
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University, Belfast, United Kingdom
| | - Ken Farrington
- Renal Department, Lister Hospital, Stevenage, United Kingdom; and
| | - Andrew Davenport
- University College London Centre for Nephrology, Royal Free Hospital, London, United Kingdom
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18
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Segall L, Nistor I, Van Biesen W, Brown EA, Heaf JG, Lindley E, Farrington K, Covic A. Dialysis modality choice in elderly patients with end-stage renal disease: a narrative review of the available evidence: Table 1. Nephrol Dial Transplant 2015; 32:41-49. [DOI: 10.1093/ndt/gfv411] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/11/2015] [Indexed: 01/08/2023] Open
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Ivarsen P, Povlsen JV. Can peritoneal dialysis be applied for unplanned initiation of chronic dialysis? Nephrol Dial Transplant 2013; 29:2201-6. [PMID: 24353321 DOI: 10.1093/ndt/gft487] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Late referral of patients with chronic kidney disease (CKD) and unforeseeable deterioration of residual renal function in known CKD patients remain a major problem leading to the need of unplanned start on chronic dialysis without a mature access for dialysis. In most centres worldwide, these patients are started on haemodialysis (HD) using a temporary tunnelled central venous catheter (CVC) for access. However, during the last decade, increasing clinical experience with unplanned start on peritoneal dialysis (PD) right after PD catheter implantation has been published. Key studies are reviewed in the present paper, and the results seem to indicate that compared with patients starting PD in a planned setting with peritoneal resting after PD catheter implantation, patients starting unplanned PD have an increased risk of mechanical complications but apparently no increased risk of infectious complications. In contrast, patients starting unplanned HD using a temporary CVC have an increased risk of both mechanical and infectious complications when compared with patients starting planned HD using an arterio-venous fistula or a permanent CVC. Regarding clinical outcome in terms of survival, unplanned PD seems to be at least as safe as unplanned HD. Combining the unplanned PD programme with a nurse-assisted PD programme is crucial in order to offer the patient a real opportunity to choose a home-based dialysis option. In conclusion, unplanned start on PD seems to be a feasible, safe and efficient alternative to unplanned start on HD for the late referred patient with end-stage renal disease and urgent need for dialysis.
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Affiliation(s)
- Per Ivarsen
- Department of Renal Medicine, Aarhus University Hospital and Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Johan V Povlsen
- Department of Renal Medicine, Aarhus University Hospital and Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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Abstract
Most patients starting dialysis can choose between peritoneal dialysis and haemodialysis. There is little evidence proving that one form of dialysis is better than the other; although there may be an early advantage to peritoneal dialysis (PD) in young patients with residual function this effect is short-lived. Technique failure develops after years on PD so dialysis modality will often change during a long dialysis career. Quality of life studies, which must be interpreted carefully, indicate that patients require information about the impact of dialysis on their lifestyle as well as health-related outcomes so that they can choose the most suitable dialysis modality. Increasing numbers of frail elderly patients are starting dialysis; support in the home by nursing staff may facilitate the use of PD in this group. In the UK guidelines prioritise the patient's choice of dialysis modality (where feasible) based on good quality predialysis education. Cost of treatment is generally lower on PD, which is particularly recommended for patients with residual renal function and few comorbidities.
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Abstract
Peritoneal dialysis is now a well established, mature treatment modality for advanced chronic kidney disease. The medium term (at least 5 year) survival of patients on peritoneal dialysis is currently equivalent to that of those on haemodialysis, and is particularly good in patients who are new to renal replacement therapy and have less comorbidity. Nevertheless the modality needs to keep pace with the constantly evolving challenges associated with the provision and delivery of health care. These challenges, which are gradually converging at a global level, include ageing of the population, multimorbidity of patients, containment of cost, increasing self care and environmental issues. In this context, peritoneal dialysis faces particular challenges that include multiple barriers to the therapy and unsatisfactory and poorly defined technique survival as well as limitations relating to intrinsic aspects of the therapy, such as peritoneal membrane longevity and hypoalbuminaemia. To move the therapy forward and favourably influence health-care policy, the peritoneal dialysis community needs to integrate their research effort more effectively by undertaking clinically meaningful studies-with a strong focus on technique survival--that are supported by multidisciplinary expertise in patient-centred outcomes, study design and analysis.
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Affiliation(s)
- Simon J Davies
- Department of Nephrology, University Hospital of North Staffordshire, Newcastle Road, Stoke on Trent, Staffordshire ST4 6QG, UK.
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22
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Oliver MJ. A Brazilian experience in assisted automated peritoneal dialysis: reliable option or just a palliative therapy? Perit Dial Int 2013; 33:230-2. [PMID: 23660604 DOI: 10.3747/pdi.2013.00027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Matthew J Oliver
- Medicine Sunnybrook Health Sciences Centre Toronto, Ontario, Canada.
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Lecouf A, Ryckelynck JP, Ficheux M, Henri P, Lobbedez T. A NEW PARADIGM: HOME THERAPY FOR PATIENTS WHO START DIALYSIS IN AN UNPLANNED WAY. J Ren Care 2013; 39 Suppl 1:50-5. [DOI: 10.1111/j.1755-6686.2013.00336.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Coentrão LA, Araújo CS, Ribeiro CA, Dias CC, Pestana MJ. Cost analysis of hemodialysis and peritoneal dialysis access in incident dialysis patients. Perit Dial Int 2013; 33:662-70. [PMID: 23455977 DOI: 10.3747/pdi.2011.00309] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although several studies have demonstrated the economic advantages of peritoneal dialysis (PD) over hemodialysis (HD), few reports in the literature have compared the costs of HD and PD access. The aim of the present study was to compare the resources required to establish and maintain the dialysis access in patients who initiated HD with a tunneled cuffed catheter (TCC) or an arteriovenous fistula (AVF) and in patients who initiated PD. METHODS We retrospectively analyzed the 152 chronic kidney disease patients who consecutively initiated dialysis treatment at our institution in 2008 (HD-AVF, n = 65; HD-CVC, n = 45; PD, n = 42). Detailed clinical and demographic information and data on access type were collected for all patients. A comprehensive measure of total dialysis access costs, including surgery, radiology, hospitalization for access complications, physician costs, and transportation costs was obtained at year 1 using an intention-to-treat approach. All resources used were valued using 2010 prices, and costs are reported in 2010 euros. RESULTS Compared with the HD-AVF and HD-TCC modalities, PD was associated with a significantly lower risk of access-related interventions (adjusted rate ratios: 1.572 and 1.433 respectively; 95% confidence intervals: 1.253 to 1.891 and 1.069 to 1.797). The mean dialysis access-related costs per patient-year at risk were €1171.6 [median: €608.8; interquartile range (IQR): €563.1 - €936.7] for PD, €1555.2 (median: €783.9; IQR: €371.4 - €1571.7) for HD-AVF, and €4208.2 (median: €1252.4; IQR: €947.9 - €2983.5) for HD-TCC (p < 0.001). In multivariate analysis, total dialysis access costs were significantly higher for the HD-TCC modality than for either PD or HD-AVF (β = -0.53; 95% CI: -1.03 to -0.02; and β = -0.50; 95% CI: -0.96 to -0.04). CONCLUSIONS Compared with patients initiating HD, those initiating PD required fewer resources to establish and maintain a dialysis access during the first year of treatment.
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Affiliation(s)
- Luis A Coentrão
- Nephrology Research and Development Unit1 and Financial Management Unit,2 São João Hospital Centre, and Department of Health Information and Decision Sciences,3 Faculty of Medicine, University of Porto, Portugal
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25
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Berger JR, Hedayati SS. Renal replacement therapy in the elderly population. Clin J Am Soc Nephrol 2012; 7:1039-46. [PMID: 22516288 DOI: 10.2215/cjn.10411011] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
ESRD has become an important problem for elderly patients. The segment of the ESRD population age 65 years or older has grown considerably, and this growth is expected to accelerate in coming years. Nephrologists caring for the elderly with advanced kidney disease will encounter patients with comorbid conditions common in younger patients, as well as physical, psychological, and social challenges that occur with increased frequency in the aging population. These challenging factors must be addressed to help inform decisions regarding the option to initiate dialysis, the choice of dialysis modality, whether to pursue kidney transplantation, and end-of-life care. This article will highlight some common problems encountered by elderly patients with ESRD and review data on the clinical outcomes of elderly patients treated with different modalities of dialysis, outcomes of kidney transplantation in the elderly, and nondialytic management of CKD stage 5.
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Affiliation(s)
- Joseph R Berger
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Xu R, Zhuo M, Yang Z, Dong J. Experiences with assisted peritoneal dialysis in China. Perit Dial Int 2011; 32:94-101. [PMID: 21632447 DOI: 10.3747/pdi.2010.00213] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE About half the patients on peritoneal dialysis (PD) in China need to be assisted by family members or home assistants. We explored whether these patients have a higher risk for peritonitis and death compared with self-care PD patients. METHODS We prospectively followed 313 incident PD patients until death or censoring. This cohort was divided into assisted and self-care PD groups according to the independence of bag exchange. Data on baseline demographics, Charlson comorbidity index, biochemistry, and residual renal function were recorded during the first 3 - 6 months. The outcome variables were first episode of peritonitis and all-cause mortality. RESULTS Of the 313 patients in this cohort study, 122 needed assistance in performing bag exchanges (86 from a family member, 36 from a home assistant); the remaining 191 patients did not need assistance. During a follow-up period averaging 44.5 months, 122 patients developed a first episode of peritonitis, and 135 patients died. Compared with patients having a family assistant, those with a home assistant had similar peritonitis-free and survival times, but a higher risk of mortality after adjustments for variables such as age, sex, Charlson comorbidity score, hemoglobin, serum albumin, and residual renal function. Furthermore, compared with self-care patients, assisted patients overall had a similar peritonitis-free time, but a higher risk of mortality, even after adjusting for covariates. CONCLUSIONS Based on our single-center experience in China, we conclude that assisted PD is a good option for patients with poor self-care ability. This result provides evidence for recruiting patients who need assistance to PD programs in China.
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Affiliation(s)
- Rong Xu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, PR China
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27
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Comparable outcome of acute unplanned peritoneal dialysis and haemodialysis. Nephrol Dial Transplant 2011; 27:375-80. [DOI: 10.1093/ndt/gfr262] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Chanliau J, Kessler M. [Peritoneal dialysis for ESRD patients: financial aspects]. Nephrol Ther 2010; 7:32-7. [PMID: 21112269 DOI: 10.1016/j.nephro.2010.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 10/10/2010] [Accepted: 10/14/2010] [Indexed: 11/18/2022]
Abstract
Peritoneal dialysis (PD) is as least as good as hemodialysis (HD) for the treatment of end stage kidney disease, considering morbidity and mortality, and better for quality of life. The best result is obtained when the patient can benefit of the sequential treatment, PD first and then HD if necessary. Furthermore, the cost of a patient treated by PD is less than the cost of the same patient treated by HD, at least in developed countries. But, all around the word, the rate of usage of PD don't grow, or decline. One can expect that, as no medical reason can explain this, the cause is economic. Multiple economics aspects and expenses posts for DP are analyzed, as the results of some financial decisions taken in one country or the other, keeping in mind the French system or reimbursement. We conclude that economic incitations may help for the development of PD, if they don't penalize one of the partners (insurance, clinics, doctors of patients), and if in the same time there is an improvement of the formation and information of doctors and patient.
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Affiliation(s)
- Jacques Chanliau
- Association lorraine de traitement de l'insuffisance rénale (ALTIR), BP 149, 54504 Vandœuvre cedex, France.
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30
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Reddy C, Dybbro PE, Guest S. Fluoroscopically guided percutaneous peritoneal dialysis catheter placement: single center experience and review of the literature. Ren Fail 2010; 32:294-9. [PMID: 20370443 DOI: 10.3109/08860220903548932] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Experiences with minimally invasive techniques for peritoneal dialysis (PD) catheter placement are being increasingly described. Percutaneous placement of catheters using ultrasound and fluoroscopic guidance has reduced the risk of complications and has led to successful long-term catheter function. An interventional radiology catheter placement capability was established at our facility and it serves as the basis for this report. We performed a retrospective analysis of patients in a tertiary care center in Northern California who required PD between July 2005 and October 2008. Patients underwent PD catheter placement in an interventional radiology suite by the radiologist using a percutaneous Seldinger technique that was guided by fluoroscopy. Sixty-four patients between the ages of 25 and 90 were referred for fluoroscopic PD catheter placement by an interventional radiologist. If clinically indicated, PD was initiated within days of catheter placement. Minor complications were noted: four with minor bleeding, three with catheter migration, and one with temporary exit-site leakage. No bowel or bladder perforations were encountered. Fluoroscopically guided PD catheter placement by interventional radiologists can be a safe and cost-effective strategy to initiate acute or chronic PD. This approach could reduce the need for temporary vascular access and expedite the initiation of PD therapy by eliminating the delays in catheter placement often associated with surgical consultation and operating room scheduling.
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Affiliation(s)
- C Reddy
- Department of Nephrology, Kaiser Permanente, Santa Clara, CA, USA.
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31
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Olsen J, Bonnevie B, Palmhøj-Nielsen C, Povlsen JV. Economic consequences of an increased number of patients on outgoing dialysis. ACTA ACUST UNITED AC 2010; 44:452-8. [PMID: 20632841 DOI: 10.3109/00365599.2010.504192] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE During the past 10 years the number of prevalent patients on dialysis treatment has doubled in Denmark and the number is expected to increase further. The majority of Danish patients on dialysis receive haemodialysis at a hospital-based centre, and increasing patient numbers will put pressure on these dialysis centres. In order to reduce this pressure, more patients will need to be offered dialysis as outgoing treatment. The aim of this study was to analyse the economic consequences of an increased number of patients on outgoing dialysis in a Danish setting. MATERIAL AND METHODS A Markov model using Danish cost estimates and clinical parameters from the Danish National Registry was developed and used to simulate changes of dialysis modalities, exits to transplantation or death as well as entry of new incident patients over a period of 10 years. RESULTS The development in total annual costs over a 10-year period showed that an increased number of patients on outgoing dialysis will lead to total savings of approximately €9.6 million. CONCLUSIONS The estimated savings of approximately €9.6 million only constitute 0.6% of the total cost of dialysis. In terms of cost over time, therefore, an increased number of patients on outgoing treatment will not lead to an increase in costs; the total cost of treatment will probably be unchanged or slightly reduced. The results were sensitive to inclusion of capital costs and exclusion of costs associated with complications or comorbidity.
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Affiliation(s)
- Jens Olsen
- Centre for Applied Health Services Research and Technology Assessment, University of Southern Denmark, Odense, Denmark.
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Covic A, Bammens B, Lobbedez T, Segall L, Heimbürger O, van Biesen W, Fouque D, Vanholder R. Educating end-stage renal disease patients on dialysis modality selection. NDT Plus 2010; 3:225-233. [PMID: 28657058 PMCID: PMC5477971 DOI: 10.1093/ndtplus/sfq059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 03/24/2010] [Indexed: 01/20/2023] Open
Affiliation(s)
- Adrian Covic
- Nephrology Clinic, 'Dr. C. I. Parhon' University Hospital, Iasi, Romania
| | - Bert Bammens
- Department of Nephrology and Renal Transplantation, University Hospitals, Leuven, Belgium
| | | | - Liviu Segall
- Nephrology Clinic, 'Dr. C. I. Parhon' University Hospital, Iasi, Romania
| | - Olof Heimbürger
- Department of Clinical Science, Karolinska Institute, Stockholm, Sweden
| | | | - Denis Fouque
- Department of Nephrology, 'E. Herriot' Hospital, Lyon, France
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Castrale C, Evans D, Verger C, Fabre E, Aguilera D, Ryckelynck JP, Lobbedez T. Peritoneal dialysis in elderly patients: report from the French Peritoneal Dialysis Registry (RDPLF). Nephrol Dial Transplant 2009; 25:255-62. [DOI: 10.1093/ndt/gfp375] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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