Home Visit Program Improves Technique Survival in Peritoneal Dialysis

Abstract

Background: Peritoneal dialysis (PD) is a home therapy, and technique survival is related to the adherence to PD prescription at home. The presence of a home visit program could improve PD outcomes. We evaluated its effects on clinical outcome during 1 year of follow-up. Methods: This was a case-control study. The case group included all 96 patients who performed PD in our center on January 1, 2013, and who attended a home visit program; the control group included all 92 patients who performed PD on January 1, 2008. The home visit program consisted of several additional visits to reinforce patients' confidence in PD management in their own environment. Outcomes were defined as technique failure, peritonitis episode, and hospitalization. Clinical and dialysis features were evaluated for each patient. Results: The case group was significantly older (p = 0.048), with a lower grade of autonomy (p = 0.033), but a better hemoglobin level (p = 0.02) than the control group. During the observational period, we had 11 episodes of technique failure. We found a significant reduction in the rate of technique failure in the case group (p = 0.004). Furthermore, survival analysis showed a significant extension of PD treatment in the patients supported by the home visit program (52 vs. 48.8 weeks, p = 0.018). We did not find any difference between the two groups in terms of peritonitis and hospitalization rate; however, trends toward a reduction of Gram-positive peritonitis rates as well as prevalence and duration of hospitalization related to PD problems were identified in the case group. The retrospective nature of the analysis was a limitation of this study. Conclusion: The home visit program improves the survival of PD patients and could reduce the rate of Gram-positive peritonitis and hospitalization. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=365168.

Remote Monitoring of Automated Peritoneal Dialysis Improves Personalization of Dialytic Prescription and Patient’s Independence

“…In the traditional monitoring system, patients or their caregivers had to take the card to the dialysis center for treatment visualization and in the case for a new prescription. Once the patients have been trained and the prescription is validated in-person, home visits are mandatory to check general patient conditions [4]. …”

“…In most countries, the cost of home therapies such as peritoneal dialysis (PD) is less and thus, any mechanisms that can increase the uptake of home therapies are likely to result in significant cost savings. It has been proved that the presence of a home visit program could improve PD outcomes [4]. There has been much interest as to whether telemedicine and RM could both increase the uptake of home therapies and improve outcomes by offering continuous medical monitoring, which not only allows verifying patient compliance but also enables identifying problems early and instituting corrective measures.…”

Remote Patient Management for Home Dialysis Patients

“… 29 Also, it has been demonstrated that frequent and regular home visits can help reduce attrition from home dialysis modalities. 30 However, home visits are costly and time consuming, and many centers cannot perform them regularly. Using virtual home visits via RPM may be a preferable substitute to an in-person home visit.…”

Causes for Withdrawal in an Urban Peritoneal Dialysis Program

“…Overall, excluding patients who may have difficulty performing the procedure (e.g., stroke, poor vision, and previous abdominal surgery), as many as 85% of stage 5 chronic kidney disease (CKD) patients are medically eligible for peritoneal dialysis [ 1 ]. However, patients on PD comprise only 10% of the entire end-stage renal disease (ESRD) population and the percentage of African-American and Hispanic ESRD patients treated with peritoneal dialysis has been consistently lower than that of White dialysis patients [ 2 ]. Surveys show that only two-thirds of ESRD patients beginning maintenance dialysis are presented with peritoneal dialysis as an option.…”