Patient-reported advantages and disadvantages of peritoneal dialysis: results from the PDOPPS

Abstract

Background Patient-reported measures are increasingly recognized as important predictors of clinical outcomes in peritoneal dialysis (PD). We sought to understand associations between patient-reported perceptions of the advantages and disadvantages of PD and clinical outcomes. Methods In this cohort study, 2760 PD patients in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) completed a questionnaire on their PD experience, between 2014 and 2017. In this questionnaire, PDOPPS patients rated 17 aspects of their PD experience on a 5-category ordinal scale, with responses scored from − 2 (major disadvantage) to + 2 (major advantage). An advantage/disadvantage score (ADS) was computed for each patient by averaging their response scores. The ADS, along with each of these 17 aspects, were used as exposures. Outcomes included mortality, transition to hemodialysis (HD), patient-reported quality of life (QOL), and depression. Cox regression was used to estimate associations between ADS and mortality, transition to HD, and a composite of the two. Logistic regression with generalized estimating equations was used to estimate cross-sectional associations of ADS with QOL and depression. Results While 7% of PD patients had an ADS < 0 (negative perception of PD), 59% had an ADS between 0 and < 1 (positive perception), and 34% had an ADS ≥1 (very positive perception). Minimal association was observed between mortality and the ADS. Compared with a very positive perception, patients with a negative perception had a higher transition rate to HD (hazard ratio [HR] = 1.67; 95% confidence interval [CI]: 1.21, 2.30). Among individual items, “space taken up by PD supplies” was commonly rated as a disadvantage and had the strongest association with transition to HD (HR = 1.28; 95% CI 1.07, 1.53). Lower ADS was strongly associated with worse QOL rating and greater depressive symptoms. Conclusions Although patients reported a generally favorable perception of PD, patient-reported disadvantages were associated with transition to HD, lower QOL, and depression. Strategies addressing these disadvantages, in particular reducing solution storage space, may improve patient outcomes and the experience of PD. Electronic supplementary material The online version of this article (10.1186/s12882-019-1304-3) contains supplementary material, which is available to authorized users.

The role of personal attitudes of control and responsibility for the uptake of peritoneal dialysis- a national survey among dialysis patients

“…Nevertheless, as PD is a home dialysis treatment that requires patients to participate and contribute, it is beneficial if patients’ personalities make them suited to the treatment. Besides patients’ personal conditions like poor mobility, comorbidities [ 38 ], a lack of space for PD supplies at home [ 39 ] or the involvement of partners [ 40 ], nephrologists should be aware of taking patients’ personality into account to get an idea whether PD could be an option for them. A review of the barriers in dialysis modality choice showed that pre-dialysis education programs and decision aids can help to enable patients to make an autonomous and confident decision when selecting a dialysis modality [ 41 ].…”

Fatigue in Incident Peritoneal Dialysis and Mortality: A Real-World Side-by-Side Study in Brazil and the United States

“…[4] Indeed, data from the Peritoneal Dialysis and Practice Patterns Study (PDOPPS) has shown patients who have a negative perception of PD modality tend to have lower HRQOL and are under a greater risk of technique failure over time. [23] We hypothesize fatigue symptoms at the transition phase to PD for kidney replacement therapy may disproportionally affect home-therapy patients, as a successful transition to dialysis requires greater patient engagement.…”

Kidney Supportive Care in Peritoneal Dialysis: Developing a Person-Centered Kidney Disease Care Plan

“… 55 The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) of over 2,700 patients undergoing PD also revealed that individuals most frequently viewed receiving treatment at home and not requiring blood access as the major advantages of PD, while feeling abdominal fullness or bloating, having their home space taken up by PD supplies, and the impact or burden on family were the most severe disadvantages. 56 These perceived disadvantages were associated with a higher likelihood of transition to HD, lower HRQoL, and higher depression scores.…”