Trends in Automated Peritoneal Dialysis Prescriptions in a Large Dialysis Organization in the United States

Abstract

Background: Changes in health care policies and recognition of patient benefit have contributed to increases in home-based dialysis, including peritoneal dialysis (PD). Frequent monitoring and early individualization of PD prescriptions are key prerequisites for the delivery of high-quality PD. The present analysis aimed to assess variations in PD prescriptions among incident automated PD (APD) patients who remain on PD for 120+ days. Methods: This retrospective analysis examined data from patients within a large dialysis organization that initiated PD with APD between 2015 and 2019. PD prescription data was described by calendar year, timing of PD, and residual renal function categories. Changes in prescriptions from PD initiation (day 1) to day 120 were assessed descriptively. Results: The cohort included 11,659 patients. The mean age at PD initiation increased from 2015 (56 (15) years) through 2019 (58 (15) years), whereas most other variables demonstrated no clear temporal change. Most patients (86%) had nighttime PD prescribed, with an average of 4.9 (1.3) cycles per day, a mean total treatment volume of 9.3 (2.5) L, and a median daily total dwell time of 7 (6,9.5) hours. Relative to day 1 nighttime prescriptions, there were 1) small increases in the proportion of patients receiving 3 or fewer cycles per day and those receiving 6+ cycles per day, 2) a 100 ml mean increase in fill volume per exchange, and 3) a mean 0.5 L increase in total nighttime treatment volume at day 120. When changes in nighttime APD prescriptions were examined at the patient level, 49% of patients had day 120 prescriptions that were unchanged from their initial prescription. Conclusions: In the largest analysis of incident APD prescriptions conducted in the United States to date, the vast majority of patients were prescribed nocturnal PD only with limited variability across the first 4 months of therapy.

Prescribing Peritoneal Dialysis in the United States

“…It is within this context that in this issue of CJASN, Giles et al 5 report the results of a cohort study assessing variations in automated PD (APD) prescriptions among 11,659 patients initiating APD between 2015 and 2019 at dialysis clinics operated by a single large dialysis organization in the United States. Only patients prescribed APD using a cycler machine and who were treated for at least 120 days were included in the study.…”