Policies to Support Home Dialysis Patients: Patients Need Help Too

Effect of Dialysis Modality on Mortality and Complications in Cardiovascular Surgery: Insights from a National Retrospective Cohort Study

Key Points

Background

Patients receiving maintenance dialysis face high mortality and complication rates after cardiovascular (CV) surgery. With the growing utilization of peritoneal dialysis (PD), it is important to understand the effect of modality (PD versus center-based hemodialysis) on outcomes after CV surgery.

Methods

This retrospective cohort study used data from the National Inpatient Sample (2016–2020) to compare outcomes of PD and hemodialysis patients undergoing coronary artery bypass grafting and surgical valve procedures. Multivariable logistic regression, negative binomial regression, and linear regression models were used, adjusting for demographic factors, comorbidities, and hospital characteristics. The primary outcome was in-hospital mortality, and secondary outcomes included prolonged ventilation, length of stay, and hospital charges.

Results

A total of 30,155 patients were included in the study, with 28,015 (92.9%) receiving hemodialysis and 2140 (7.1%) receiving PD. Compared with hemodialysis, PD was associated with lower in-hospital mortality (odds ratio, 0.61; 95% confidence interval [CI], 0.38 to 0.97), reduced prolonged ventilation (odds ratio, 0.51; 95% CI, 0.32 to 0.81), shorter length of stay (incidence rate ratio, 0.85; 95% CI, 0.80 to 0.91), and decreased hospital charges (mean difference, −$87,172 USD; 95% CI, −$113,523 to −$60,820) compared with hemodialysis. Among PD patients, postoperative transition to hemodialysis was associated with worse outcomes.

Conclusions

Maintaining PD during the perioperative period may confer benefits over hemodialysis, including lower hospital charges and improved patient outcomes. Careful consideration of dialysis modality in the management of CV surgery patients is needed to optimize clinical outcomes and reduce health care costs.

Analysis of a nurse-provided on-call peritoneal dialysis support in an outpatient reference care centre

BACKGROUND

To analyse the nature of medical or technical emergency issues of ambulatory peritoneal dialysis (PD) patients calling a nurse-provided emergency PD support service of a reference centre that is provided all year in the after-hours.

METHODS

We retrospectively analysed patients' chief complaint, urgency, resolution of and association to current PD treatment and modality directed to an on-call nurse-provided PD support service from 2015-2021 based on routinely collected health data. Calls were systematically categorized being technical/procedural-, medical-, material-related or type of correspondence. Call urgency was categorized to have "immediate consequence", inquiry was eligible for "processing next working day" or whether there was "no need for further action". Call outcomes were classified according to whether patients were able to initiate, resume or finalize their treatments or whether additional interventions were required. Unexpected adverse events such as patients' acute hospitalization or need for nurses' home visits were evaluated and quantified.

RESULTS

In total 753 calls were documented. Most calls were made around 7:30 a.m. (5:00-9:00; median, 25-75th CI) and 6:30 p.m. (5:00-8:15). 645 calls were assigned to continuous ambulatory- (CAPD) or automated PD (APD). Of those, 430 calls (66.7%) had an "immediate consequence". Of those 77% (N = 331) were technical/procedural-, 12.8% (N = 55) medical- and 6.3% (N = 27) material related issues. 4% (N = 17) were categorized as other correspondence. Issues disrupting the course of PD were identified in 413 cases. In 77.5% (N = 320) patients were able to initiate, resume or finalize their treatment after phone consultation. Last-bag exchange was used in 6.1% enabling continued therapy in 83.6%. In 35 cases a nurse visit at patients' home or patients' visit to the practice at the earliest possible date were required, while hospitalization was required in seven medical category cases (5.4% and 1.09% of total assessed calls, respectively).

CONCLUSION

The on-call PD-nurse provides patient support for acute and imminent issues enabling them to successfully initiate, resume or finalize their prescribed treatment. Nurses triage of acute conditions facilitated rapid diagnostics and therapy. Maintaining quality PD homecare, the provision of trained personnel is indispensable. The information gathered in this study may therefore be used as a foundation to tailor educational programs for nephrology nurses and doctors to further develop their competencies in PD.