Predicting a patient's choice of dialysis modality:Experience in a United Kingdom renal department

Little, Jane A.; Irwin, Adam; Marshall, T.; Rayner, Hugh; Smith, Stephen H.

doi:10.1016/s0272-6386(05)80014-9

Cited by 146 publications

(158 citation statements)

References 9 publications

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“…Many studies have demonstrated that self-care difficulties contribute to the underutilization of PD as a kidney replacement therapy (1)(2)(3). Accordingly, assisted PD provides a good alternative in Europe.…”

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confidence: 99%

Experiences with Assisted Peritoneal Dialysis in China

Zhuo

Yang

et al. 2012

Perit Dial Int

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♦ Objective: About half the patients on peritoneal dialysis (PD) in China need to be assisted by family members or home assistants. We explored whether these patients have a higher risk for peritonitis and death compared with self-care PD patients. ♦ Methods: We prospectively followed 313 incident PD patients until death or censoring. This cohort was divided into assisted and self-care PD groups according to the independence of bag exchange. Data on baseline demographics, Charlson comorbidity index, biochemistry, and residual renal function were recorded during the first 3 -6 months. The outcome variables were first episode of peritonitis and all-cause mortality. ♦ Results: Of the 313 patients in this cohort study, 122 needed assistance in performing bag exchanges (86 from a family member, 36 from a home assistant); the remaining 191 patients did not need assistance. During a follow-up period averaging 44.5 months, 122 patients developed a first episode of peritonitis, and 135 patients died. Compared with patients having a family assistant, those with a home assistant had similar peritonitis-free and survival times, but a higher risk of mortality after adjustments for variables such as age, sex, Charlson comorbidity score, hemoglobin, serum albumin, and residual renal function. Furthermore, compared with self-care patients, assisted patients overall had a similar peritonitis-free time, but a higher risk of mortality, even after adjusting for covariates. ♦ Conclusions: Based on our single-center experience in China, we conclude that assisted PD is a good option for patients with poor self-care ability. This result provides evidence for recruiting patients who need assistance to PD programs in China. Although peritoneal dialysis (PD) has many advantages, such as ease of training and accommodation, simple facilities, and good mobility, the procedure is difficult for patients who are physically disabled or noncompliant. Many studies have demonstrated that self-care difficulties contribute to the underutilization of PD as a kidney replacement therapy (1-3). Accordingly, assisted PD provides a good alternative in Europe. Lobbedez et al. (4) found that, compared with self-care patients, patients with nurse assistance had a higher peritonitis rate and a lower technique survival rate. Povlsen et al. (5) reported a higher risk of peritonitis and mortality in assisted patients than in autonomous patients, all of whom were elderly (>65 years) and receiving automated PD.The reasons that may potentially lead to unfavorable outcomes in assisted PD include inconsistent home care and inadequate training and education for assistants (6). However, in the past few years in our PD patient pool, patients and their home care providers have both been trained at dialysis initiation to be familiar with the procedures of bag exchange, volume control, and blood pressure and glucose monitoring. The major sources of home care providers are stable and provide good training.We conducted the present study to examine the risk factors for perito...

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confidence: 99%

Experiences with Assisted Peritoneal Dialysis in China

Zhuo

Yang

et al. 2012

Perit Dial Int

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“…Patients have a strong preference for the status quo and are reluctant to change treatments, especially in the context of emergency HD (24). Timely decisions on dialysis modality are likely to favor PD, and yet as many as 61% of CKD patients in Singapore end up on emergency dialysis (25)(26)(27)(28)(29)(30).…”

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confidence: 99%

Perspectives of Patients, Families, and Health Care Professionals on Decision-Making about Dialysis Modality—the Good, the Bad, and the Misunderstandings!

Griva

Lai

et al. 2012

Perit Dial Int

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♦ Objectives: This study explored the factors influencing decision-making about dialysis modality, integrating the perspectives of patients, their families, and health care professionals within an Asian population. The study further sought to understand the low penetration rate of peritoneal dialysis (PD) in Singapore. ♦ Methods: A sample of 59 participants comprising pre-dialysis patients, dialysis patients, caregivers, and health care professionals (HCPs) participated in semistructured interviews to explore the decision-making process and their views about various dialysis modalities. Data were thematically analyzed using NVivo9 (QSR International, Doncaster, Australia) to explore barriers to and facilitators of various dialysis modalities and decisional support needs. ♦ Results: Fear of infection, daily commitment to PD, and misperceptions of PD emerged as barriers to PD. Side effects, distance to dialysis centers, and fear of needling and pain were barriers to hemodialysis (HD). The experiences of other patients, communicated informally or opportunistically, influenced the preferences and choices of patients and family members for a dialysis modality. Patients and families value input from HCPs and yet express strong needs to discuss subjective experiences of life on dialysis (PD or HD) with other patients before making a decision about dialysis modality. ♦ Conclusions: Pre-dialysis education should expand its focus on the family as the unit of care and should provide opportunities for interaction with dialysis patients and for peer-led learning. Barriers to PD, especially misperceptions and misunderstandings, can be targeted to improve PD uptake.

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“…In earlier work, the presence of cerebrovascular disease, peripheral vascular disease, hypertension, coronary artery disease, congestive heart failure, and left ventricular hypertrophy have been linked to the selection of FhD over PD (12,13,16).…”

Section: Resultsmentioning

confidence: 99%