Impact of the implementation of an assisted peritoneal dialysis service on peritoneal dialysis initiation

Boyer, Annabel; Solis-Trapala, Ivonne; Tabinor, Matthew; Davies, Simon; Lambie, Mark

doi:10.1093/ndt/gfz287

Cited by 32 publications

(31 citation statements)

References 53 publications

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“…Patients in the assisted PD group were older, more likely to be female, more prevalent in diabetes and cardiovascular disease and carried a heavier burden of comorbid diseases than patients in the self-care PD group. Similar to our study, Boyer et al showed that patients starting PD with assistance were older than those starting unassisted (70.0 (61.5-78.3) vs 58.7 (43.8-69.2) years) 12 . In another study from France, Lobbedez et al reported that assisted PD patients were older (74 ± 10.4 vs 52 ± 18.6 years, P < 0.001) and presented more comorbidity (CCI 7 ± 2.5 vs 4.3 ± 2.4, P < 0.05) compared with selfcare patients 22 .…”

Section: Discussionsupporting

confidence: 91%

“…Assisted PD is de ned as PD treatment performed at the patient's home and with the assistance of a family member, a partner, a community nurse or a healthcare technician 11 . 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 .…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 91%

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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“…Our study also shows that, due to a decline in family assistance, assisted PD currently relies mainly on nurse assistance. It has been demonstrated that widespread adoption of assisted PD services would significantly increase PD initiation [ 46 ]. Although there are added costs to nurse-assisted PD, a Netherlands study demonstrated that it is a cost-effective option [ 47 ] in elderly patients.…”

Section: Discussionmentioning

confidence: 99%

Trends in assisted peritoneal dialysis over the last decade: a cohort study from the French Peritoneal Dialysis Registry

Boyer

Lanot

Lambie

et al. 2020

Clinical Kidney Journal

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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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“…This is largely because many patients who could benefit from PD experience physical and/or cognitive barriers to managing dialysis by themselves [8], and also lack the supports needed to compensate. Indeed, providing home supports to these patients has increased uptake of PD is some areas, like the UK and Canada [16, 17]. However, in other places, like France, it has not [12].…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile in France, where there exists a well-funded aPD program, the median age of patients on PD is 71 years [14]. PD uptake improved with a HR of 1.13 (95% CI 1.05–1.21) for increased rate of CAPD utilization for nurse-assisted PD patients [16]. This relationship is corroborated in another study looking at 134 incident ESRD patients in Ontario, 80% of whom had at least 1 personal barrier to self-care PD [17].…”

Section: Assisted Peritoneal Dialysismentioning

confidence: 99%

Health Outcomes and Cost Considerations of Assisted Peritoneal Dialysis: A Narrative Review

Maierean

Oliver

2021

Blood Purif

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Background: Peritoneal dialysis (PD) is underutilized in many parts of the world despite pro-PD health policies. The physical and cognitive demands of PD means that over half of eligible patients require some form of assistance. As such, many countries now offer assisted PD (aPD) programs to help patients start or stay on PD as opposed to in-center hemodialysis (HD). In order to evaluate the potential scope of aPD, it is important to review the outcomes and cost considerations of aPD. Summary: We reviewed available data from different countries and regions for health outcomes between aPD and in-center HD, with a focus on quality of life (QoL), mortality, hospitalization, and technique survival. We also evaluated studies discussing the overall costs of delivering aPD, including training, operating costs, and indirect costs and compared these to in-center HD costs for the same regions. Key Messages: aPD patients are older and more frail than either self-care PD patients and many in-center HD patients. We found no evidence for any difference in QoL, mortality, or hospitalization between aPD and in-center HD after adjustment for these differences. There is some evidence for an association between nurse assistance and improved technique survival as compared to family assistance or self-care PD. Despite increased cost of providing assistance in PD, it is still significantly less expensive than in-center HD in Western Europe and Canada.

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Impact of the implementation of an assisted peritoneal dialysis service on peritoneal dialysis initiation

Cited by 32 publications

References 53 publications

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

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

Trends in assisted peritoneal dialysis over the last decade: a cohort study from the French Peritoneal Dialysis Registry

Health Outcomes and Cost Considerations of Assisted Peritoneal Dialysis: A Narrative Review

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