Comparison of cost-utility between automated peritoneal dialysis and continuous ambulatory peritoneal dialysis

Peritoneal dialysis in the modern era

The practice and clinical outcomes of peritoneal dialysis (PD) have demonstrated significant improvement over the past 20 years. The aim of this review is to increase awareness and update healthcare professionals on current PD practice, especially with respect to patient and technique survival, patient modality selection, pathways onto PD, understanding patient experience of care and use prior to kidney transplantation. These improvements have been impacted, at least in part, by greater emphasis on shared decision-making in dialysis modality selection, the use of advanced laparoscopic techniques for PD catheter implantation, developments in PD connecting systems, glucose-sparing strategies, and modernising technology in managing automated PD patients remotely. Evidence-based clinical guidelines such as those prepared by national and international societies such as the International Society of PD have contributed to improved PD practice underpinned by a recognition of the place of continuous quality improvement processes.

Impact of dialysis modality conversion on the health-related quality of life of peritoneal dialysis patients: a retrospective cohort study in China

BACKGROUND

To analyze the health-related quality of life associated with the conversion of dialysis modality among end-stage renal disease patients in China.

METHODS

Patients were recruited from hospitals and a dialysis center in Kunshan, China. Patients converting from continuous ambulatory peritoneal dialysis to automated peritoneal dialysis were recruited as the observation group (n = 64), and patients continuing with continuous ambulatory peritoneal dialysis treatment were included in the control group (n = 64) after matching in this retrospective cohort study. Their health-related quality of life was measured using the kidney disease quality of life instrument in 2019 and 2020, respectively. Baseline socio-demographic characteristics and clinical data were collected in 2019. The before-and-after cross-group comparisons of subscale scores of two groups were conducted using a Student's t-test. Multiple linear regression models were fitted to identify the factors associated with the change of each scale.

RESULTS

The health-related quality of life scores of the two groups was comparable in baseline, while the observation group had higher scores in Physical Component Summary (51.92 ± 7.50), Kidney Disease Component Summary (81.21 ± 8.41), Symptoms (90.76 ± 6.30), Effects (82.86 ± 11.42), and Burden (69.04 ± 15.69) subscales after one year. In multivariate regression analysis, the change of Physical Component Summary was significantly associated with conversion to APD (β = 11.54, 95% CI [7.26-15.82]); the change of Mental Component Summary with higher education (β =  - 5.96, 95% CI [-10.18--1.74]) and CCI (>2) (β = 5.39, 95% CI [1.05-9.73]); the change of Kidney Disease Component Summary with conversion to APD (β = 15.95, 95% CI [10.19-21.7]) and age (>60 years) (β =  - 7.36, 95% CI [-14.11--0.61]); the change of Symptoms with CCI (>2) (β = 7.96, 95% CI [1.49-14.44]); the change of Effects with conversion to APD (β = 19.23, 95% CI [11.57-26.88]); and the change of Burden with conversion to APD (β = 22.40, 95% CI [13.46-31.34]), age (>60 years) (β =  - 12.12, 95% CI [-22.59--1.65]), and higher education (β =  - 10.38, 95% CI [-19.79--0.98]).

CONCLUSIONS

The conversion of dialysis modality had a significant impact on the scores of most subscales. Patients converting from continuous ambulatory peritoneal dialysis to automated peritoneal dialysis generally had improved health-related quality of life scores.

Influence of Systemic Administration of Coq10 Nanoparticles on Ischemia-Reperfusion Injury on Ovaries in Rat

Using a rat ovary model, effects of COQ10 nanoparticles (NCOQ10) were studied on ischemia-reperfusion injury. In the present experimental study, following randomization of thirty healthy female Wistar rats ∼250 g, the animals were subjected to five experimental groups (n = 6): group SHAM : only laparotomy was performed, group IS: only a 3-hour ischemia was performed, group IS/REP: the procedure included a 3-hour ischemia followed by a 3-hour reperfusion, and 50 µL soybean oil (solvent of NCOQ10) was administered 30 min before cessation of reperfusion, group IS/NCOQ10: the procedure included a 3-hour ischemia only and 50 µL (0.3 mmol/lit/IP) of NCOQ10 30 min before cessation of ischemia, and group IS/REP/NCOQ10: the procedure included a 3-hour ischemia, a 3-hour reperfusion, and 20 µL (0.3 mmol/lit) of NCOQ10 30 min before cessation of ischemia. Significantly amended development of ischemia/reperfusion tissue injury was observed in animals treated with NCOQ10 compared to those of other groups (P=0.001). Mean values of biochemical indices were significantly higher than those observed for other groups (P=0.001). Significantly lower values of MDA were observed in IS/REP/NCOQ10 animals compared to those of other groups (P=0.001).Where ovarian tissue is exposed to ischemia, intraperitoneal administration of NCOQ10 could bear clinical benefits in diminishing ischemia-reperfusion injury.

Kidney Disease-Specific Scores and Health Utility of Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis Patients and Their Caregivers

OBJECTIVES

This study aimed to compare the EuroQol 5-dimension 5-level questionnaire (EQ-5D-5L), the visual analogue scale (VAS), and the Kidney Disease Quality of Life 36-Item Short-Form Survey (KDQOL-36) scores of Thai continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) patients and to compare the utility scores with the EQ-5D-5L and VAS scores of caregivers.

METHODS

This was a cross-sectional study completed between April 2016 and May 2017. In total, 34 CAPD patients, 30 APD patients, and their caregivers were recruited from a large university hospital in Thailand. A trained interviewer conducted face-to-face interviews. We collected demographic data and used the KDQOL-36 and EuroQol questionnaires (EQ-5D-5L and VAS) to assess the health-related quality of life. Caregivers were asked to assess their own health status using the EQ-5D-5L and VAS.

RESULTS

The EQ-5D-5L and VAS responses of the CAPD and APD patients and their caregivers were not significantly different (P > .05). More than 50% of both patient groups had mobility problems, whereas most patients had no problems with self-care, doing usual activities, pain or discomfort, and anxiety or depression. As for the KDQOL-36, the physical and mental component summaries were not significantly different, and neither were the scores for all of the kidney disease-specific dimensions, including symptoms or problems, effects of kidney disease, and burden of kidney disease (all were P > .05).

CONCLUSIONS

The results indicated that the quality of life of CAPD and APD patients and their caregivers were mostly equivalent. A further longitudinal study of utility score assessments of the differences in modality would be advantageous.

Health-related quality of life in peritoneal dialysis patients: A narrative review

Health-related quality of life (HRQOL) is an important aspect of patients´ health that should be an integral part of the evaluation of patient-centered outcomes, not least because HRQOL associates with patients´ morbidity and mortality. This applies also to chronic kidney disease patients, including those dependent on renal replacement therapies, the type of which may influence patients´ perception of HRQOL. Several studies have addressed HRQOL in chronic kidney disease patients undergoing renal replacement therapies, especially transplanted patients and hemodialysis patients, while publications concerning peritoneal dialysis (PD) patients are scarcer. This review describes some of the methods used to assess HRQOL, factors influencing HRQOL in PD patients, HRQOL in PD vs hemodialysis, and the relation between HRQOL and patient outcomes. We conclude that assessment of HRQOL-often neglected at present-should be included as a standard measure of patient-centered outcomes and when monitoring the quality and effectiveness of renal care including PD treatment.

Interaperitoneal Administration of Αlpha-Tocopherol Loaded Nanoparticles Improves Ischemia-Reperfusion Injury in Rat Ovaries Torsion and Detorsion Model

Objective:

To investigate effects of intraperitoneally administration of α-tocopherol loaded nanoparticles (TNP) on ischemia-reperfusion injury in ovaries.

Methods:

Thirty-five healthy female Wistar rats ~250g were randomized into seven experimental groups (n = 5): Group SHAM: The rats underwent only laparotomy. Group Ischemia: A 3- hour ischemia only. Group I/R: A 3-hour ischemia and a 3-hour reperfusion. Group I/T: A 3-hour ischemia only and 100 mg/kg intraperitoneal administration (IP) of α-tocopherol 2.5 hours after induction of ischemia. Group I/R/T: A 3-hour ischemia, a 3-hour reperfusion and 100 mg/kg IP of α-tocopherol 2.5 hours after induction of ischemia. Group I/TNP: A 3-hour ischemia only and 1 mg/kg IP of TNP 2.5 hours after induction of ischemia. Group I/R/TNP: A 3-hour ischemia, a 3-hour reperfusion and 1 mg/kg IP of TNP 2.5 hours after induction of ischemia.  

Results:

Animals treated with αTNP showed significantly ameliorated development of ischemia and reperfusion tissue injury compared to those of other groups (p=0.001). The significant higher values of SOD, tGSH, GPO, GSHRd and GST were observed in I/R/NC animals compared to those of other groups (p=0.001). Damage indicators (NOS, MDA, MPO and DNA damage level) were significantly lower in I/R/NC animal compared to those of other groups (p=0.001).

Conclusion:

Intraperitoneal administration of TNP could be helpful in minimizing ischemia-reperfusion injury in ovarian tissue exposed to ischemia.

Economic costs of automated and continuous ambulatory peritoneal dialysis in Taiwan: a combined survey and retrospective cohort analysis

OBJECTIVES

Taiwan succeeded in raising the proportion of peritoneal dialysis (PD) usage after the National Health Insurance (NHI) payment scheme introduced financial incentives in 2005. This study aims to compare the economic costs between automated PD (APD) and continuous ambulatory PD (CAPD) modalities from a societal perspective.

DESIGN AND SETTING

A retrospective cohort of patients receiving PD from the NHI Research Database was identified during 2004-2011. The 1:1 propensity score matched 1749 APD patients and 1749 CAPD patients who were analysed on their NHI-financed medical costs and utilisation. A multicentre study by face-to-face interviews on 117 APD and 129 CAPD patients from five hospitals located in four regions of Taiwan was further carried out to collect data on their out-of-pocket payments, productivity losses and quality of life with EuroQol-5D-5L.

OUTCOME MEASURES

The NHI-financed medical costs, out-of-pocket payments and productivity losses of APD and CAPD patients.

RESULTS

The total NHI-financed medical costs per patient-year after 5 years of follow-up were significantly higher with APD than CAPD (US$23 005 vs US$19 237; p<0.01). In terms of dialysis-related costs, APD had higher costs resulting from the use of APD machines (US$795) and APD sets (US$2913). Significantly lower productivity losses were found with APD (US$2619) than CAPD (US$6443), but the out-of-pocket payments were not significantly different. The differences in NHI-financed medical costs and productivity losses between APD and CAPD remained robust in the bootstrap analysis. The total economic costs of APD (US$30 401) were similar to those of CAPD (US$29 939), even after bootstrap analysis (APD, US$28 399; CAPD, US$27 960). No discernable differences were found in the results of mortality and quality of life between the APD and CAPD patients.

CONCLUSIONS

APD had higher annual dialysis-related costs and lower annual productivity losses than CAPD, which made the economic costs of APD very close to those of CAPD in Taiwan.

Medical Expenditure for Chronic Diseases in Mexico: The Case of Selected Diagnoses Treated by the Largest Care Providers

BACKGROUND

Chronic diseases (CD) are a public health emergency in Mexico. Despite concern regarding the financial burden of CDs in the country, economic studies have focused only on diabetes, hypertension, and cancer. Furthermore, these estimated financial burdens were based on hypothetical epidemiology models or ideal healthcare scenarios. The present study estimates the annual expenditure per patient and the financial burden for the nine most prevalent CDs, excluding cancer, for each of the two largest public health providers in the country: the Ministry of Health (MoH) and the Mexican Institute of Social Security (IMSS).

METHODS

Using the Mexican National Health and Nutrition Survey 2012 (ENSANUT) as the main source of data, health services consumption related to CDs was obtained from patient reports. Unit costs for each provided health service (e.g. consultation, drugs, hospitalization) were obtained from official reports. Prevalence data was obtained from the published literature. Annual expenditure due to health services consumption was calculated by multiplying the quantity of services consumed by the unit cost of each health service.

RESULTS

The most expensive CD in both health institutions was chronic kidney disease (CKD), with an annual unit cost for MoH per patient of US$ 8,966 while for IMSS the expenditure was US$ 9,091. Four CDs (CKD, arterial hypertension, type 2 diabetes, and chronic ischemic heart disease) accounted for 88% of the total CDs financial burden (US$ 1.42 billion) in MoH and 85% (US$ 3.96 billion) in IMSS. The financial burden of the nine CDs analyzed represents 8% and 25% of the total annual MoH and IMSS health expenditure, respectively.

CONCLUSIONS/SIGNIFICANCE

The financial burden from the nine most prevalent CDs, excluding cancer, is already high in Mexico. This finding by itself argues for the need to improve health promotion and disease detection, diagnosis, and treatment to ensure CD primary and secondary prevention. If the status quo remains, the financial burden could be higher.

Association between serum leptin levels and peritoneal dialysis: A meta-analysis

There is limited information available with regard to the association between serum leptin levels, or other adipokines, and serum lipid levels and insulin sensitivity in patients undergoing peritoneal dialysis (PD). Thus, the aim of the present study was to perform a meta-analysis investigating this association. Potential relevant studies were identified through searching the following databases: MEDLINE, Science Citation Index, Cochrane Library, PubMed, Embase, CINAHL, Chinese Biomedical, Chinese Journal Full-Text and Weipu Journal. Statistical analyses were calculated using version 12.0 STATA software. In total, 21 case-control studies comprising 1,187 subjects (574 patients and 613 controls) were collected for the meta-analysis. The results identified a statistically significant difference in the serum levels of leptin when comparing the PD patients with the healthy controls [controls vs. cases, standardized mean difference (SMD), 2.09; 95% confidence interval (CI), 1.58-2.59; P<0.001]. Furthermore, ethnicity-subgroup analysis indicated that the PD patients of Asian and Caucasian populations were associated with increased serum levels of leptin (Asian population, SMD, 2.05; 95% CI, 1.48-2.62; P<0.001; Caucasian population, SMD, 2.19; 95% CI, 1.19-3.18; P<0.001). Therefore, serum leptin levels may be used as a prognostic marker for PD.