A Systematic Review and Jurisdictional Scan of the Evidence Characterizing and Evaluating Assisted Peritoneal Dialysis Models

Hofmeister, Mark; Klarenbach, Scott; Soril, Lesley; Scott-Douglas, Nairne; Clement, Fiona

doi:10.2215/cjn.11951019

Cited by 22 publications

(26 citation statements)

References 41 publications

(132 reference statements)

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“…Payment to the medical staff assisting with PD in the home could not come directly from the dialysis organization or healthcare provider, as this could be construed as an “inducement” and would violate the Stark Law. New processes and regulatory endorsement for payment are necessary to increase enthusiasm to apply this as an approach to increase home access 22 . For many ESKD patients, particularly elderly patients in the COVID era, assisted PD may be more optimal than in‐center HD, potentially reducing exposure risk for infection in transit or within the clinic itself.…”

Section: Novel Models Of Carementioning

confidence: 99%

Barriers to home dialysis: Unraveling the tapestry of policy

Fissell

Cavanaugh

2020

Seminars in Dialysis

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Home dialysis therapies for end-stage kidney disease (ESKD), both hemodialysis (HD) and peritoneal dialysis (PD), are underutilized in the United States. The Advancing American Kidney Health (AAKH) Initiative makes clear that initiating and maintaining dialysis patients on home therapies is a national priority. 1 There are several key reasons driving this U.S. policy proceeding. Compared to in-center HD, home dialysis can usually be provided at a lower cost. 2 Home dialysis also allows for more flexible patient-centered schedules, and therefore may contribute to a higher quality of life. 3 Although often debated, evidence suggests that more gradual removal of fluid and solutes is clinically beneficial compared to intermittent removal with the relatively shorter HD treatments provided in outpatient HD units. 4 Recent events due to the COVID-19 pandemic have prompted not only the urgency of home dialysis but its expanded use through widespread authority to provide care through telehealth visits as a mechanism for dialysis patients to safely remain at home. 5 It is not clear that these important changes in delivery of dialysis will continue into the future, and it is only a small component of the necessary strategies to increase access to home dialysis. Several professional societies have met recently, to provide guidance for overcoming operational and policy barriers to home dialysis. 6,7 Sustained, successful home dialysis requires effective and persistent coordination between multiple supportive entities. These include surgeons, home therapy nurses, nephrologists, hospitals, and their staff, and in many cases a caregiver in the home. Advocacy from the local community, and the nephrology community more broadly, is a fundamental requisite to demonstrate to regulatory stakeholders that polices directed at increasing home dialysis access are desired by those who receive and deliver this type of healthcare. Policy is a powerful lever to drive initial action, direct talent, and various resources, and ensure the highest quality of care. The purpose of this review is to provide an overview of where policy, in addition to nephrologist and dialysis center reimbursement, may be needed to support expanded use of home dialysis therapies (Table 1).

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Section: Novel Models Of Carementioning

confidence: 99%

Barriers to home dialysis: Unraveling the tapestry of policy

Fissell

Cavanaugh

2020

Seminars in Dialysis

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“…Direct visualization of the peritoneum and placement of PD catheter by advanced laparoscopy has been very successful in most instances [34,35]. Frailty, advanced age, poor vision, psychiatric or memory issues and lack of motor skills are not contraindications to PD but mere barriers that can be overcome with assisted PD, either provided by the family members at home or by trained personnel at home or nursing facilities [36][37][38][39][40]. Assisted PD programs have been successful in other countries such as Canada, Denmark, and France [38,[41][42][43].…”

Section: Patients Selectionmentioning

confidence: 99%

How To Build a Successful Urgent-Start Peritoneal Dialysis Program

Rajora

Shastri

Pirwani³

et al. 2020

Kidney360

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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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“…As a feasible option for patients who cannot perform their own PD exchanges, assisted PD have been developed in many countries with the aim of overcoming barriers in older and nonself-su cient patients, and some studies suggested that the use of assisted PD could increase the utilization of PD patients among older [12][13][14] . However, whether assisted PD achieved similar outcomes to self-care peritoneal dialysis still remained controversial 15 . Therefore, we conducted the present study to investigate the outcomes of assisted PD in ageing patients, by comparing patients undergoing assisted PD with those on self-care PD in a cohort of older patients.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Survival Between Assisted Peritoneal Dialysis and Self-Care Peritoneal Dialysis Patients Aged 70 or Older

Song¹,

H²,

Z³

et al. 2021

Preprint

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Introduction: Assisted PD is used as an alternative option for the growing group of frail, older ESRD patients unable to perform their own PD. This study was undertaken to investigate the outcomes of assisted PD in older patients by comparing assisted PD patients with self-care PD patients. Methods This study included all patients aged 70 or older who started on PD in our hospital from 2009 to 2018. Patients were divided into assisted PD group and self-care PD group according to the independence of bag exchange, and followed up until death, PD cessation or to the end of the study (December 31, 2019). Survival curves were generated using the Kaplan-Meier method and risk factors associated with mortality, peritonitis and technique failure were evaluated using both cause-specific hazards and subdistribution hazards models. Results 180 patients were enrolled, including 106 (58.9%) males with a median age of 77.5 (77.2–81.2) years. Among the 180 patients, 62 patients (34.4%) were assisted. Patients in the assisted PD group were older, more likely to be female, more prevalent in DM and CVD, with a higher Charlson score than patients in the self-care PD group (P all < 0.05). In the multivariable analysis, assisted patients had a comparable patient survival and peritonitis-free survival compared to self-care PD patients either in the Cox or in the FG models. According to a Cox model, the use of assisted PD was associated with a lower risk of technique failure (cs-HR 0.20, 95% CI 0.04–0.76), but the association lost its statistical significance in the Fine and Gray model. Conclusions No significant difference in patient survival and peritonitis-free survival were found between the assisted PD patients and self-care PD patients. Moreover, assisted PD might protect older patients incapable of self-care from technique failure. Therefore, we suggested that assisted PD could be a safe and effective RRT modality for older ESRD patients who need assistance.

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A Systematic Review and Jurisdictional Scan of the Evidence Characterizing and Evaluating Assisted Peritoneal Dialysis Models

Cited by 22 publications

References 41 publications

Barriers to home dialysis: Unraveling the tapestry of policy

Barriers to home dialysis: Unraveling the tapestry of policy

How To Build a Successful Urgent-Start Peritoneal Dialysis Program

Comparison of Survival Between Assisted Peritoneal Dialysis and Self-Care Peritoneal Dialysis Patients Aged 70 or Older

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