Peritoneal Dialysis use within the Context of the Population and Healthcare Systems of Europe -Differences, Trends and Future Challenges

Machowska, Anna; Rutherford, Peter

doi:10.5301/ijao.5000499

Cited by 10 publications

(8 citation statements)

References 32 publications

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“…The departments seemed to be following shared decision-making principles, such that the physicians’ opinions affected patient choice. However, the patient:nephrologist ratio was not a factor, in accordance with previous findings for Europe [ 44 ]. Patients treated by physicians with lengthy specialist experience were—perhaps surprisingly—less likely to be informed of and less likely to choose home dialysis.…”

Section: Discussionsupporting

confidence: 91%

Choice of dialysis modality among patients initiating dialysis: results of the Peridialysis study

Heaf

Heiro

Petersons

et al. 2020

Clinical Kidney Journal

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Background In patients with end-stage kidney disease (ESKD), home dialysis offers socioeconomic and health benefits compared to in-centre dialysis but is generally underutilized. We hypothesized that pre-dialysis course and institutional factors affect choice of dialysis modality after dialysis initiation (DI). Methods The Peridialysis study is a multinational, multicentre prospective observational study assessing the causes and timing of DI and consequences of suboptimal DI. Clinical and biochemical data, details of the pre-dialytic course, reasons for DI and causes of choice of dialysis modality were registered. Results Among 1587 included patients, 516 (32.5%) were judged unsuitable for home dialysis due to contraindications (384; 24.2%) or no assessment (106; 6.7%; mainly due to late referral and/or suboptimal DI) or death (26; 1.6%). High age, comorbidity, late referral, suboptimal DI, acute illness, and rapid loss of renal function associated with unsuitability. Of the remaining 1071 patients, 700 (65.4%) chose peritoneal dialysis (61.7%) or home haemodialysis (3.6%), while 371 (34.6%) chose in-centre HD. Somatic differences between patients choosing home dialysis and in-centre dialysis were minor; factors linked to choice of in-centre dialysis were late referral, suboptimal DI, acute illness and absence of a “home dialysis first” institutional policy. Conclusions Given a personal choice with shared decision making, 65.4% of ESKD patients choose home dialysis. Our data indicate that the incidence of home dialysis potentially could be further increased to reducing the incidence of late referral and unplanned DI, and, in acutely ill patients, by implementing an educational program after improvement of their clinical condition.

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Section: Discussionsupporting

confidence: 91%

Choice of dialysis modality among patients initiating dialysis: results of the Peridialysis study

Heaf

Heiro

Petersons

et al. 2020

Clinical Kidney Journal

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“…This last study of regional variation does raise an issue also observed in this study – the country of the study site was a predictor of the likelihood to receive education in UPS. The geographical variation in PD use across Europe is well known and has not changed in the past 20–30 years 29. This appears to reflect physician belief and practice patterns, which are also playing out within the context of the current study.…”

Section: Discussionmentioning

confidence: 53%

Factors influencing access to education, decision making, and receipt of preferred dialysis modality in unplanned dialysis start patients

Machowska¹,

Alscher²,

Vanga³

et al. 2016

PPA

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ObjectivesUnplanned dialysis start (UPS) leads to worse clinical outcomes than planned start, and only a minority of patients ever receive education on this topic and are able to make a modality choice, particularly for home dialysis. This study aimed to determine the predictive factors for patients receiving education, making a decision, and receiving their preferred modality choice in UPS patients following a UPS educational program (UPS-EP).MethodsThe Offering Patients Therapy Options in Unplanned Start (OPTiONS) study examined the impact of the implementation of a specific UPS-EP, including decision support tools and pathway improvement on dialysis modality choice. Linear regression models were used to examine the factors predicting three key steps: referral and receipt of UPS-EP, modality decision making, and actual delivery of preferred modality choice. A simple economic assessment was performed to examine the potential benefit of implementing UPS-EP in terms of dialysis costs.ResultsThe majority of UPS patients could receive UPS-EP (214/270 patients) and were able to make a decision (177/214), although not all patients received their preferred choice (159/177). Regression analysis demonstrated that the initial dialysis modality was a predictive factor for referral and receipt of UPS-EP and modality decision making. In contrast, age was a predictor for referral and receipt of UPS-EP only, and comorbidity was not a predictor for any step, except for myocardial infarction, which was a weak predictor for lower likelihood of receiving preferred modality. Country practices predicted UPS-EP receipt and decision making. Economic analysis demonstrated the potential benefit of UPS-EP implementation because dialysis modality costs were associated with modality distribution driven by patient preference.ConclusionEducation and decision support can allow UPS patients to understand their options and choose dialysis modality, and attention needs to be focused on ensuring equity of access to educational programs, especially for the elderly. Physician practice and culture across units/countries is an important predictor of UPS patient management and modality choice independent of patient-related factors. Additional work is required to understand and improve patient pathways to ensure that modality preference is enacted. There appears to be a cost benefit of delivering education, supporting choice, and ensuring that the choice is enacted in UPS patients.

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“…The diffusion of peritoneal dialysis (PD) differs from country to country. The treatment is widely used in both rich and poor settings, in Canada, Australia and New Zealand, where distances make home treatment preferable, as well as in Mexico and Taiwan, where less expensive treatment options are chosen because of budgetary constraints [95,96,97,98,99,100,101,102].…”

Section: A Fundamental Question: Haemodialysis or Peritoneal Dialymentioning

confidence: 99%

“…Cost issues are, however, not limited to the emerging countries, since the weight of dialysis is remarkable in all contexts, and the increase in home treatments, and in particular in home haemodialysis, is advocated as a means to optimize costs and resources, with clinical outcomes at least equivalent to hospital dialysis [99,100,101,102].…”

Section: A Fundamental Question: Haemodialysis or Peritoneal Dialymentioning

confidence: 99%

“…The availability of assisted peritoneal dialysis programs could profoundly change the penetration of peritoneal dialysis, in particular in elderly patients. However, the lower prevalence of PD in France, where assisted PD is the rule, as compared to Italy, where assisted PD is not available, once more indicates that things are not as simple as they may seem, and that economic incentives and drawbacks are just some of the potential factors determining treatment choices [96,97,98,99,100,101,102].…”

Section: A Fundamental Question: Haemodialysis or Peritoneal Dialymentioning

confidence: 99%

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Dialysis Reimbursement: What Impact Do Different Models Have on Clinical Choices?

Piccoli

Cabiddu

Breuer

et al. 2019

JCM

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Allowing patients to live for decades without the function of a vital organ is a medical miracle, but one that is not without cost both in terms of morbidity and quality of life and in economic terms. Renal replacement therapy (RRT) consumes between 2% and 5% of the overall health care expenditure in countries where dialysis is available without restrictions. While transplantation is the preferred treatment in patients without contraindications, old age and comorbidity limit its indications, and low organ availability may result in long waiting times. As a consequence, 30–70% of the patients depend on dialysis, which remains the main determinant of the cost of RRT. Costs of dialysis are differently defined, and its reimbursement follows different rules. There are three main ways of establishing dialysis reimbursement. The first involves dividing dialysis into a series of elements and reimbursing each one separately (dialysis itself, medications, drugs, transportation, hospitalisation, etc.). The second, known as the capitation system, consists of merging these elements in a per capita reimbursement, while the third, usually called the bundle system, entails identifying a core of procedures intrinsically linked to treatment (e.g., dialysis sessions, tests, intradialyitc drugs). Each one has advantages and drawbacks, and impacts differently on the organization and delivery of care: payment per session may favour fragmentation and make a global appraisal difficult; a correct capitation system needs a careful correction for comorbidity, and may exacerbate competition between public and private settings, the latter aiming at selecting the least complex cases; a bundle system, in which the main elements linked to the dialysis sessions are considered together, may be a good compromise but risks penalising complex patients, and requires a rapid adaptation to treatment changes. Retarding dialysis is a clinical and economical goal, but the incentives for predialysis care are not established and its development may be unfavourable for the provider. A closer cooperation between policymakers, economists and nephrologists is needed to ensure a high quality of dialysis care.

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Peritoneal Dialysis use within the Context of the Population and Healthcare Systems of Europe -Differences, Trends and Future Challenges

Cited by 10 publications

References 32 publications

Choice of dialysis modality among patients initiating dialysis: results of the Peridialysis study

Choice of dialysis modality among patients initiating dialysis: results of the Peridialysis study

Factors influencing access to education, decision making, and receipt of preferred dialysis modality in unplanned dialysis start patients

Dialysis Reimbursement: What Impact Do Different Models Have on Clinical Choices?

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