Abstract:Background
Patients receiving peritoneal dialysis (PD) endure an ongoing regimen of daily fluid exchanges and are at risk of potentially life-threatening complications and debilitating symptoms that can limit their ability to participate in life activities. The aim of the study was to identify the characteristics, content and psychometric properties of measures for life participation used in research in PD.
Methods
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“…In 2022, the International Society for Peritoneal Dialysis (ISPD) published its standardized definition for PD-related peritonitis, which should be diagnosed when at least two of the following are present: clinical features consistent with peritonitis (that is, abdominal pain and/or cloudy dialysis effluent); dialysis effluent white cell count >100/”l or >0.1 Ă 10 9 /l (after a dwell time of at least 2 h), with >50% polymorphonuclear leukocytes; and positive dialysis effluent culture 23 . Work is currently underway to develop validated outcomes for technique survival and life participation 24 , 25 . Fig.…”
Section: Standardizing and Prioritizing Pd Outcomesmentioning
confidence: 99%
“…Life participation, which is a SONG-PD core outcome 21 , is not uniformly assessed or reported across PD studies. A systematic review identified 42 different measures used for assessment of life participation, of which 36% were specifically designed to assess life participation and 64% assessed broader constructs, which suggests that these measures vary in their characteristics, content and validation 24 .…”
Section: Global Patient-reported Pd Outcomesmentioning
confidence: 99%
“…Although both dimensions are often reported together, the obligatory components are more likely to be reported than non-obligatory dimensions (for example, socializing and recreation) 104 â 107 . For instance, the SONG-PD group found that 76% of studies reported both dimensions; an additional 14% and 10% of studies reported obligatory and non-obligatory dimensions, respectively 24 . Patients receiving PD often have a better employment status than those treated with HD 106 â 110 , probably because they need to spend less time in a treatment facility.…”
Section: Global Patient-reported Pd Outcomesmentioning
Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous potential advantages, including a simpler technique, greater feasibility of use in remote communities, generally lower cost, lesser need for trained staff, fewer management challenges during natural disasters, possibly better survival in the first few years, greater ability to travel, fewer dietary restrictions, better preservation of residual kidney function, greater treatment satisfaction, better quality of life, better outcomes following subsequent kidney transplantation, delayed need for vascular access (especially in small children), reduced need for erythropoiesis-stimulating agents, and lower risk of blood-borne virus infections and of SARS-CoV-2 infection. PD outcomes have been improving over time but with great variability, driven by individual and system-level inequities and by centre effects; this variation is exacerbated by a lack of standardized outcome definitions. Potential strategies for outcome improvement include enhanced standardization, monitoring and reporting of PD outcomes, and the implementation of continuous quality improvement programmes and of PD-specific interventions, such as incremental PD, the use of biocompatible PD solutions and remote PD monitoring.
“…In 2022, the International Society for Peritoneal Dialysis (ISPD) published its standardized definition for PD-related peritonitis, which should be diagnosed when at least two of the following are present: clinical features consistent with peritonitis (that is, abdominal pain and/or cloudy dialysis effluent); dialysis effluent white cell count >100/”l or >0.1 Ă 10 9 /l (after a dwell time of at least 2 h), with >50% polymorphonuclear leukocytes; and positive dialysis effluent culture 23 . Work is currently underway to develop validated outcomes for technique survival and life participation 24 , 25 . Fig.…”
Section: Standardizing and Prioritizing Pd Outcomesmentioning
confidence: 99%
“…Life participation, which is a SONG-PD core outcome 21 , is not uniformly assessed or reported across PD studies. A systematic review identified 42 different measures used for assessment of life participation, of which 36% were specifically designed to assess life participation and 64% assessed broader constructs, which suggests that these measures vary in their characteristics, content and validation 24 .…”
Section: Global Patient-reported Pd Outcomesmentioning
confidence: 99%
“…Although both dimensions are often reported together, the obligatory components are more likely to be reported than non-obligatory dimensions (for example, socializing and recreation) 104 â 107 . For instance, the SONG-PD group found that 76% of studies reported both dimensions; an additional 14% and 10% of studies reported obligatory and non-obligatory dimensions, respectively 24 . Patients receiving PD often have a better employment status than those treated with HD 106 â 110 , probably because they need to spend less time in a treatment facility.…”
Section: Global Patient-reported Pd Outcomesmentioning
Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous potential advantages, including a simpler technique, greater feasibility of use in remote communities, generally lower cost, lesser need for trained staff, fewer management challenges during natural disasters, possibly better survival in the first few years, greater ability to travel, fewer dietary restrictions, better preservation of residual kidney function, greater treatment satisfaction, better quality of life, better outcomes following subsequent kidney transplantation, delayed need for vascular access (especially in small children), reduced need for erythropoiesis-stimulating agents, and lower risk of blood-borne virus infections and of SARS-CoV-2 infection. PD outcomes have been improving over time but with great variability, driven by individual and system-level inequities and by centre effects; this variation is exacerbated by a lack of standardized outcome definitions. Potential strategies for outcome improvement include enhanced standardization, monitoring and reporting of PD outcomes, and the implementation of continuous quality improvement programmes and of PD-specific interventions, such as incremental PD, the use of biocompatible PD solutions and remote PD monitoring.
“…Compared to ICHD, PD gives the opportunity to dialyze at home, independently or with the help of a caregiver. Additionally, the short amount of time required for fluid exchange allows a flexible schedule and the opportunity to work, travel or participate in recreational activities [179][180][181]. Using the KDQOL SF 1.3, Wakeel et al compared the QoL of 200 patients on ICHD or PD in Saudi Arabia.…”
Section: Quality Of Life On the Transplant Waiting Listmentioning
Kidney transplantation (KT) is recognized as the gold-standard of treatment for patients with end-stage renal disease. Additionally, it has been demonstrated that receiving a pre-emptive KT ensures the best recipient and graft survivals. However, due to an overwhelming discrepancy between the organs available and the patients on the transplant waiting list, the vast majority of transplant candidates require prolonged periods of dialysis before being transplanted. For many years, peritoneal dialysis (PD) and hemodialysis (HD) have been considered competitive renal replacement therapies (RRT). This dualistic vision has recently been questioned by evidence suggesting that an individualized and flexible approach may be more appropriate. In fact, tailored and cleverly planned changes between different RRT modalities, according to the patientâs needs and characteristics, are often needed in order to achieve the best results. While home HD is still under scrutiny in this particular setting, current data seems to favor the use of PD over in-center HD in patients awaiting a KT. In this specific population, the demonstrated advantages of PD are superior quality of life, longer preservation of residual renal function, lower incidence of delayed graft function, better recipient survival, and reduced cost.
“…Life participation is defined as the ability to participate in activities that are meaningful and important to patients. 1,2 Life participation may encompass activities including, but not limited to, paid and voluntary work, housework, family duties, study, travel, hobbies and recreational activities. 3,4 Life participation is an intrinsically important outcome to people on peritoneal dialysis (PD), which they consider to be an indicator of their treatment success.…”
Background: Life participation is an outcome of critical importance to patients receiving peritoneal dialysis (PD). However, there is no widely accepted or validated tool for measuring life participation in patients receiving PD. Methods: Online consensus workshop to identify the essential characteristics of life participation as a core outcome, with the goal of establishing a patient-reported outcome measure for use in all trials in patients receiving PD. Thematic analysis of transcripts was performed. Results: Fifty-five participants, including 17 patients and caregivers, from 15 countries convened via online videoconference. Four themes were identified: reconfiguring expectations of daily living (accepting day-to-day fluctuation as the norm, shifting thresholds of acceptability, preserving gains in flexibility and freedom), ensuring broad applicability and interpretability (establishing cross-cultural relevance, incorporating valued activities, distinguishing unmodifiable barriers to life participation), capturing transitions between modalities and how they affect life participation (responsive to trajectory towards stable, reflecting changes with dialysis transitions) and maximising feasibility of implementation (reducing completion burden, administrable with ease and flexibility). Conclusions: There is a need for a validated, generalisable outcome measure for life participation in patients receiving PD. Feasibility, including length of time to complete and flexible mode of delivery, are important to allow implementation in all trials that include patients receiving PD.
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