Compliance Study in Peritoneal Dialysis Using Pdadequest Software

Abstract

Poor compliance in peritoneal dialysis (PD) is a significant cause of dropout and morbidity. PD Adequest software, which, through a mathematical model, predicts the effect of the dialysis prescription on the basis of the peritoneal transport, may be used to identify the noncompliant patient. Fifty patients from two dialysis centers, aged 65.9±1.5 years and on PD for 28.6±4.7 months, were studied. A peritoneal equilibration test (PET) was carried out and 24hour urine and dialysate were collected. Total weekly creatinine clearance (CrCI, L/week/1.73 m2) was calculated, as well as the glomerular filtration rate [(GFR), mL/min, mean CrCI and urea nitrogen clearance (UNCI)]. The dialytic schedules used were then introduced into the program and the parameters were recalculated using the software model. Nine patients considered noncompliant from their case histories were used to assess the differences of reference between expected and measured values. The control group was significantly different from the noncompliant group in the percentage of the CrCI and the serum creatinine (sCR) differences. The noncompliance threshold value was calculated from the mean of the lower 95% confidence interval of the compliant group and the higher one of the noncompliant group (-5.3%) for CrCI and vice versa for sCR (+10%), which behaved to the contrary. Reassessing the patients, 11 (22%) were identified as probably noncompliant.

Non-Adherence in Patients on Peritoneal Dialysis: A Systematic Review

“…As seen in Table 2 , approximately half (N = 12) of the included adherence-related studies were conducted in North America [3] , [4] , [23] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , six were conducted in Europe [35] , [36] , [37] , [38] , [39] , [40] , and six studies were conducted in Asia [41] , [42] , [43] , [44] , [45] , [46] . One study was conducted in South America [47] .…”

“…More than half (N = 15) of the included studies were cross-sectional [3] , [4] , [23] , [26] , [27] , [33] , [34] , [35] , [36] , [37] , [41] , [43] , [44] , [46] , [47] , with another seven as longitudinal [30] , [31] , [32] , [39] , [40] , [42] , [45] . Two were retrospective investigations [28] , [38] .…”

“…The majority of the studies (80%; N = 20) examined adherence with regards to only one aspect of treatment regimen – either dialysis procedures [3] , [4] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [35] , [37] , [38] , [39] , [47] , medication [34] , [36] , [43] or diet/fluid restrictions [42] , [45] . Two studies considered at least two of these aspects [23] , [40] and another three studies considered all three aspects of treatment (dialysis, medication and diet) [41] , [44] , [46] .…”

Automated Peritoneal Dialysis Symposium: Role of APD in Compliance with Therapy

“…The Cockroft–Gault formula for predicting creatinine excretion obtained from predominantly male patients with a glomerular filtration rate (GFR) of at least 11 ml/min seems unlikely to be an accurate predictor of creatinine excretion in ESRD, whose creatinine clearance is nearly always less than 10 ml/min. Other proposed methods include taking an inventory of the PD supplies (5); the medication event monitoring system (MEMS; Apprex, Menlo Park, CA), by which patients are required to pull the tabs from the dialysis bags and place them in the MEMS bottle (10); comparison of predicted Kt / V and creatinine clearance with measured Kt / V and creatinine clearance, computed with modeling software (this is based on the assumption that noncompliance produces an accumulation of solutes because of reduced dialysis (11); and a memory card, capable of tracking and storing 2 months of treatment (12). It can be incorporated into the commercial PD cycler and gives detailed information about the time of the exchange, length of the exchange, solution transit time, drain time, automated exchanges and last fill, inflow and drain volume, net ultrafiltration, and times of drain alarms.…”

Assessing Compliance with Peritoneal Dialysis

“…Social support, depression, and patient perceptions of their well being and quality of life may affect compliance with ESRD, particularly when they are on PD (19). Up to now, except for a study from Italy (20) and one from Switzerland (9), all other studies have been performed in Canada and United States. Since it is possible that compliance may be related to various national characteristics it is desirable to do similar studies in other countries and such studies may contribute to international differences in PD outcome.…”