Patient Preference Trade-offs for Next-Generation Kidney Replacement Therapies

Peritoneal Dialysis (PD) Patient and Nurse Preferences around Novel and Standard Automated PD Device Features

Key Points

Adoption and extended time on peritoneal dialysis require patient input across a spectrum of needs, including automated PD (APD) device usability features that are less intimidating to patients and enable lifestyle advantages. Analysis of APD features critical to patients align with patient priorities identified in Standardized Outcomes in NephroloGy-PD: shorter setup time, mobility within the home, near silent operation, and modified APD size/orientation.

Background

Despite offering greater lifestyle benefits to patients with ESKD, adoption of peritoneal dialysis (PD) remains low globally, particularly among minorities and the socioeconomically disadvantaged. While automated PD (APD) affords a high potential for reducing the burden of KRT, understanding patient preferences is critical to guiding development of new and improved APD devices to better accommodate use in their daily lives.

Methods

A quantitative cross-sectional survey study was performed using adaptive conjoint analysis to quantify APD feature preferences among patients on PD, PD Registered Nurses (RNs), and non-PD patients to ascertain the relative importance of eight specific cycler attributes, including portability, noise, setup time, device size, setup directions, battery power, consumables, and PD RN control (PD RNs only), each with 2–3 descriptive feature levels.

Results

Forty-two patients on PD, 24 non-PD patients, and 52 PD RNs were surveyed. Preference shares spanned nearly the entire range from 0% to 100%, indicating strong preference discrimination. For all groups, “Portability in the Home,” “Noise Level,” and “Setup Time” were the most important features. Patients on PD gave highest priority to these features compared with other study participants, plausibly as features enabling improved lifestyle. A simulated “coat rack” style cycler with extended battery power that was easy to move in the home, silent, required only 10-minute setup, and had a fully animated instruction screen was preferred by all groups >90% compared with features present in existing cyclers.

Conclusions

Addressing APD cycler technical and therapy-related issues to improve usability, comfort, and convenience within the home may affect PD uptake and retention. Attention and priority must be given to patient-centric APD cycler design directed at including features that improve quality of life for the device end user.

From Home to Wearable Hemodialysis: Barriers, Progress, and Opportunities

Although the past two decades have seen substantial proportional growth of home hemodialysis in the United States, the absolute number of patients treated with home hemodialysis remains small. Currently available stationary hemodialysis devices for use in the home have inherent limitations that represent barriers for more widespread adoption by a larger proportion of individuals with kidney failure. These limitations include device weight and bulk, ergonomics considerations, technical complexity, vascular access challenges, and limited remote patient monitoring. Recent years have witnessed a resurgence in research and development of prototype wearable kidney replacement devices incorporating innovations in miniaturization, new biomaterials, and new methods for toxin clearance and dialysate regeneration. Recent work has built on five decades of incremental innovation in wearable dialysis concepts and prototypes, starting from the work by Kolff in the 1970s. Wearable dialysis devices that successfully overcome key persistent barriers to successful development and adoption of these technologies will radically reshape the landscape of kidney replacement therapies and have the potential to dramatically improve the lives of individuals living with kidney failure.