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Cortvrindt C, Van Biesen W, Gambino G, Clause AL. Factors influencing renal replacement therapy modality choice from the nephrologist's perspective. J Nephrol 2024:10.1007/s40620-024-01915-w. [PMID: 38512379 DOI: 10.1007/s40620-024-01915-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/24/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Peritoneal dialysis (PD) offers quality of life and empowerment for persons with end-stage kidney disease (ESKD). Nevertheless, the prevalence of PD is low in Belgium and Europe in general. Reimbursement, patient mix and late referral have been quoted as underlying reasons. However, to date no one-size-fits-all solution increasing uptake of PD has been successfully implemented. We aimed to understand the nephrologist's perspective, beliefs, and experiences on dialysis modality selection and to clarify underlying process-level and intrinsic motivations steering final decisions. METHODS Using purposeful sampling, Belgian nephrologists (non-/academic, geographical spread, age, gender) were selected. We conducted semi-structured interviews, and audiotapes were transcribed verbatim. Meaningful units were grouped into (sub-)themes, and a conceptual framework was developed using grounded theory according to Charmaz as guidance. RESULTS Twenty-nine nephrologists were interviewed. We identified four themes: Trust and belief (in PD as a technique; own expertise, knowledge and team; in behavior of patient, family practitioner), feeling of control (paternalism; insecurity; prejudice), vision of care and approach (shared decision making; troubleshooting attitude; flexibility and creativity; complacency), and organizational issues (predialysis; access; financial; and assisted PD). CONCLUSIONS Based on these interviews, it is apparent that next to already identified singular issues such as late referral, predialysis education, patient mix and financial incentives, more intrinsic factors also impact uptake of home-based therapies. These factors intertwine and relate both to process-level topics and to attitudes and culture of the nephrologists within the team.
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Affiliation(s)
| | - Wim Van Biesen
- Renal Division, University Hospital Gent, Gent, Belgium.
- Department of Internal Medicine and Paediatrics, University of Gent, Ghent, Belgium.
| | - Guiseppe Gambino
- Service de Néphrologie dialyse et transplantation, Hôpital Erasme, ULB, Brussels, Belgium
| | - Anne-Lorraine Clause
- Service de Néphrologie dialyse et transplantation, Hôpital Erasme, ULB, Brussels, Belgium
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Sun X, McKeaveney C, Shields J, Chan CP, Henderson M, Fitzell F, Noble H, O'Neill S. Rate and reasons for peritoneal dialysis dropout following haemodialysis to peritoneal dialysis switch: a systematic review and meta-analysis. BMC Nephrol 2024; 25:99. [PMID: 38493084 PMCID: PMC10943899 DOI: 10.1186/s12882-024-03542-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Patient experiences and survival outcomes can be influenced by the circumstances related to dialysis initiation and subsequent modality choices. This systematic review and meta-analysis aimed to explore the rate and reasons for peritoneal dialysis (PD) dropout following haemodialysis (HD) to PD switch. METHOD This systematic review conducted searches in four databases, including Medline, PubMed, Embase, and Cochrane. The protocol was registered on PROSPERO (study ID: CRD42023405718). Outcomes included factors leading to the switch from HD to PD, the rate and reasons for PD dropout and mortality difference in two groups (PD first group versus HD to PD group). The Critical Appraisal Skills Programme (CASP) checklist and the GRADE tool were used to assess quality. RESULTS 4971 papers were detected, and 13 studies were included. On meta-analysis, there was no statistically significant difference in PD dropout in the PD first group (OR: 0.81; 95%CI: 0.61, 1.09; I2 = 83%; P = 0.16), however, there was a statistically significant reduction in the rate of mortality (OR: 0.48; 95%CI: 0.25, 0.92; I2 = 73%; P = 0.03) compared to the HD to PD group. The primary reasons for HD to PD switch, included vascular access failure, patient preference, social issues, and cardiovascular disease. Causes for PD dropout differed between the two groups, but inadequate dialysis and peritonitis were the main reasons for PD dropout in both groups. CONCLUSION Compared to the PD first group, a previous HD history may not impact PD dropout rates for patients, but it could impact mortality in the HD to PD group. The reasons for PD dropout differed between the two groups, with no statistical differences. Psychosocial reasons for PD dropout are valuable to further research. Additionally, establishing a consensus on the definition of PD dropout is crucial for future studies.
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Affiliation(s)
- Xingge Sun
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Rd, Belfast, BT9 7BL, UK
| | - Clare McKeaveney
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Rd, Belfast, BT9 7BL, UK
| | - Joanne Shields
- Regional Nephrology & Transplant Unit, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, UK
| | - Chi Peng Chan
- Regional Nephrology & Transplant Unit, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, UK
| | - Matthew Henderson
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, Belfast, BT9 7BL, UK
| | - Fiona Fitzell
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, Belfast, BT9 7BL, UK
| | - Helen Noble
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Rd, Belfast, BT9 7BL, UK
| | - Stephen O'Neill
- Regional Nephrology & Transplant Unit, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, UK.
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, Belfast, BT9 7BL, UK.
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El Bardai G, Chouhani BA, Kabbali N, Najdi A, Arrayhani M, Sqalli Houssaini T. Early and Late Patient Outcomes in Urgent-Start Peritoneal Dialysis: A Prospective Study of Unplanned Initiation of Chronic Dialysis. Cureus 2022; 14:e31254. [PMID: 36382328 PMCID: PMC9642965 DOI: 10.7759/cureus.31254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Peritoneal dialysis (PD) has become a well-established complementary alternative to hemodialysis (HD) as the first-line renal replacement modality. Unlike the temporary catheter for hemodialysis that can be used immediately after implementation, the PD catheter usage period remains controversial. The aim of this study was to compare the short- and long-term outcomes in patients under peritoneal dialysis according to the delay of starting the dialysis after catheter placement. Methods: This observational prospective study was conducted over an eight-year and four-month period (from April 2014 to August 2021), including all patients treated with peritoneal dialysis for 18 months (from April 2014 to October 2015). The patients were divided into two groups according to whether the catheter was used during the first 15 days (PD-E) or 15 days after (PD-L) catheter placement. The primary outcomes were early complications (mechanical and infectious) within 90 days. Secondary outcomes included technique survival. Results: Among the 36 patients included in the study, 14 started PD early (38.8%), while 22 started it 15 days after catheter placement (61.2%). The mean age between the two groups was not significantly different (41 ± 17 years vs 35 ± 16 years, p: not significant). There were no significant differences in the Charlson comorbidity index or the degree of autonomy. The incidence of infections was not significantly different between the two groups (13.6% in PD-L vs 21.4% in PD-E, p: not significant). The total number of mechanical complications was not significantly higher in the PD-E group compared to the PD-L group (42.8% vs 27.3%, respectively, p: not significant). Kaplan-Meier estimates of technique survival were comparable between the groups (log Rank: 1.908, p: 0.67). Conclusions: Our study showed no increase in the risk of complications associated with early use of the PD catheter and no difference in technique survival. PD can be used as first-line renal replacement therapy in the unplanned initiation of chronic dialysis.
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Hahn Lundström U, Abrahams AC, Allen J, Altabas K, Béchade C, Burkhalter F, Clause AL, Corbett RW, Eden G, François K, de Laforcade L, Lambie M, Martin H, Pajek J, Panuccio V, Ros-Ruiz S, Steubl D, Vega A, Wojtaszek E, Zaloszyc A, Davies SJ, Van Biesen W, Gudmundsdottir H. Barriers and opportunities to increase PD incidence and prevalence: Lessons from a European Survey. Perit Dial Int 2021; 41:542-551. [PMID: 34409901 DOI: 10.1177/08968608211034988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Peritoneal dialysis (PD) remains underutilised and unplanned start of dialysis further diminishes the likelihood of patients starting on PD, although outcomes are equal to haemodialysis (HD). METHODS A survey was sent to members of EuroPD and regional societies presenting a case vignette of a 48-year-old woman not previously known to the nephrology department and who arrives at the emergency department with established end-stage kidney disease (unplanned start), asking which dialysis modality would most likely be chosen at their respective centre. We assessed associations between the modality choices for this case vignette and centre characteristics and PD-related practices. RESULTS Of 575 respondents, 32.8%, 32.2% and 35.0% indicated they would start unplanned PD, unplanned HD or unplanned HD with intention to educate patient on PD later, respectively. Likelihood for unplanned start of PD was only associated with quality of structure of the pre-dialysis program. Structure of pre-dialysis education program, PD program in general, likelihood to provide education on PD to unplanned starters, good collaboration with the PD access team and taking initiatives to enhance home-based therapies increased the likelihood unplanned patients would end up on PD. CONCLUSIONS Well-structured pre-dialysis education on PD as a modality, good connections to dedicated PD catheter placement teams and additional initiatives to enhance home-based therapies are key to grow PD programs. Centres motivated to grow their PD programs seem to find solutions to do so.
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Affiliation(s)
- Ulrika Hahn Lundström
- Division of Renal Medicine, 206106Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Alferso C Abrahams
- Department of Nephrology and Hypertension, 8124University Medical Center Utrecht, The Netherlands
| | - Jennifer Allen
- Renal and Transplant Unit, 9820Nottingham University NHS Trust, UK
| | - Karmela Altabas
- Division of Nephrology and Dialysis, Clinical Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Clémence Béchade
- Service Néphrologie-Dialyse-Transplantation, Normandie University, UNICAEN, CHU de Caen Normandie, Caen, France
| | - Felix Burkhalter
- Division of Nephrology, University Clinic of Medicine, 367307Kantonsspital Baselland, Liestal, Switzerland
| | | | - Richard W Corbett
- Renal and Transplant Centre, Hammersmith Hospital, 8946Imperial College Healthcare NHS Trust, London, UK
| | - Gabriele Eden
- Medical Clinic V: Nephrology
- Rheumatology
- Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Karlien François
- Division of Nephrology and Hypertension, Vrije Universiteit Brussel, 60201Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Louis de Laforcade
- Service d'Endocrinologie-Néphrologie, 377376Centre Hospitalier Pierre Oudot, Bourgoin-Jallieu, France
| | - Mark Lambie
- Institute of Applied Clinical Sciences, Keele University, Stoke on Trent, UK
| | | | - Jernej Pajek
- Department of Nephrology, 37663University Medical Centre Ljubljana, Slovenia and Medical Faculty, University of Ljubljana, Slovenia
| | - Vincenzo Panuccio
- Nephrology, Dialysis and Renal Transplant Unit, Grande Ospedale Metropolitano 'Bianchi Melacrino Morelli', Reggio Calabria, Italy
| | - Silvia Ros-Ruiz
- Department of Nephrology, Elche University General Hospital, Alicante, Spain
| | - Dominik Steubl
- Department of Nephrology, Faculty of Medicine, 27190Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Almudena Vega
- Department of Nephrology, 16483Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ewa Wojtaszek
- Department of Nephrology, Dialysis and Internal Diseases, 37803The Medical University of Warsaw, Poland
| | - Ariane Zaloszyc
- Department of Pediatrics 1, 27083University Hospital of Strasbourg, Strasbourg, France
| | - Simon J Davies
- Faculty of Medicine and Health Science, Keele University, Stoke on Trent, UK
| | - Wim Van Biesen
- Department of Nephrology, 26656Ghent University Hospital, Belgium
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Boyer A, Lanot A, Lambie M, Verger C, Guillouet S, Lobbedez T, Béchade C. Trends in Peritoneal Dialysis Technique Survival, Death, and Transfer to Hemodialysis: A Decade of Data from the RDPLF. Am J Nephrol 2021; 52:318-327. [PMID: 33906190 DOI: 10.1159/000515472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/24/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION There is limited information on the trends of peritoneal dialysis (PD) technique survival over time. This study aimed to estimate the effect of calendar time on technique survival, transfer to hemodialysis (HD) (and the individual causes of transfer), and patient survival. METHODS This retrospective, multicenter study, based on data from the French Language Peritoneal Dialysis Registry, analyzed 14,673 patients who initiated PD in France between January 1, 2005, and December 31, 2016. Adjusted Cox regressions with robust variance were used to examine the probability of a composite end point of either death or transfer to HD, death, and transfer to HD, accounting for the nonlinear impact of PD start time. RESULTS There were 10,201 (69.5%) cases of PD cessation over the study period: 5,495 (37.4%) deaths and 4,706 (32.1%) transfers to HD. The rate of PD cessation due to death or transfer to HD decreased over time (PR 0.96, 95% CI: 0.95-0.97). Compared to 2009-2010, starting PD between 2005 and 2008 or 2011 and 2016 was strongly associated with a lower rate of transfer to HD (PR 0.88, 95% CI: 0.81-0.96, and PR 0.91, 95% CI: 0.84-0.99, respectively), mostly due to a decline in the rate of infection-related transfers to HD (PR 0.96, 95% CI: 0.94-0.98). CONCLUSIONS Rates of the composite end point of either death or transfer to HD, death, and transfer to HD have decreased in recent decades. The decline in transfers to HD rates, observed since 2011, is mainly the result of a significant decline in infection-related transfers.
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Affiliation(s)
- Annabel Boyer
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen, France
- U1086 INSERM, ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
| | - Antoine Lanot
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen, France
- U1086 INSERM, ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen, France
| | - Mark Lambie
- Renal Unit, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
- Faculty of Medicine and Health Sciences, Keele University, Newcastle, United Kingdom
| | | | - Sonia Guillouet
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen, France
- U1086 INSERM, ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen, France
| | - Thierry Lobbedez
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen, France
- U1086 INSERM, ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen, France
| | - Clémence Béchade
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen, France
- U1086 INSERM, ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen, France
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Liu X, Qin A, Zhou H, He X, Cader S, Wang S, Tang Y, Qin W. Novel Predictors and Risk Score of Treatment Failure in Peritoneal Dialysis-Related Peritonitis. Front Med (Lausanne) 2021; 8:639744. [PMID: 33842502 PMCID: PMC8033636 DOI: 10.3389/fmed.2021.639744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/18/2021] [Indexed: 02/05/2023] Open
Abstract
Objective: Peritonitis is a severe complication in peritoneal dialysis (PD). This study was performed to identify predictors and establish a risk score for treatment failure in peritonitis patients. Methods: A single-center, retrospective observational study was conducted. The basic demographic characteristics, clinical and laboratory data of all patients with peritonitis during the study period were documented and analyzed. Multivariate logistic regression was applied to examine independent predictors of treatment failure, and a risk prediction score was established. Results: Three hundred fourteen episodes experienced by 241 patients were included in the final analysis. Logistic regression analysis indicated that PD duration (OR 1.017; P 0.005), fibrinogen (OR 1.327; P 0.021), high-density lipoprotein (OR 0.443; P 0.032), fungal infection (OR 63.413; P < 0.001), intestinal obstruction (OR 5.186, P 0.007), and diabetes mellitus (OR 2.451; P 0.018), hemodialysis history (OR 2.804, P 0.006) were independent predictors of treatment failure. The risk prediction score system showed a good calibration (P > 0.05) and discrimination (AUROC 0.80, P < 0.001). Conclusions: Fibrinogen, PD duration, fungal infection, hemodialysis history, concurrent intestinal obstruction, or diabetes mellitus were independent risk factors for a poor peritonitis outcome, while the high-density lipoprotein was a protective factor. This novel risk prediction score system may be used to predict a high risk of treatment failure effectively.
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Affiliation(s)
- Xiang Liu
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Aiya Qin
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Huan Zhou
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Xueqin He
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Shamlin Cader
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Sirui Wang
- Outpatient Department, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Tang
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Qin
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China
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Boyer A, Lanot A, Lambie M, Guillouet S, Lobbedez T, Béchade C. Trends in assisted peritoneal dialysis over the last decade: a cohort study from the French Peritoneal Dialysis Registry. Clin Kidney J 2021; 13:1003-1011. [PMID: 33391743 PMCID: PMC7769513 DOI: 10.1093/ckj/sfaa051] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/26/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is limited information available on the use of assisted peritoneal dialysis (PD) over time and the impact of economic incentives on its utilization. The aim of this study was to describe the trends in assisted PD utilization and the type of assistance provided. We wanted to estimate if an economic incentive implemented in 2011 in France was associated with an increase in the utilization of nurse-assisted PD. METHODS This retrospective, multicentre study, based on data from the French Language Peritoneal Dialysis Registry, analysed 11 987 patients who initiated PD in France between 1 January 2006 and 31 December 2015. Adjusted Cox regression with robust variance was used to examine the initiation of assisted PD, both nurse-assisted and family-assisted, accounting for the nonlinear impact of the PD starting time. RESULTS There were 6149 (51%) incident patients on assisted PD, 5052 (82%) on nurse-assisted PD and 1097 (18%) on family-assisted PD over the study period. In the adjusted analysis, calendar time was associated with the assisted PD rate: it declined from 2008 until 2013 before flattening out and then it increased after 2014. Nurse-assisted PD utilization increased significantly after 2012, whereas family-assisted PD utilization decreased linearly over time (prevalence ratio = 0.94, 95% confidence interval 0.92-0.97). CONCLUSIONS The assisted PD rate decreased until 2013, mainly because of a decline in family-assisted PD. The uptake in nurse-assisted PD observed from 2013 reflects the effect of an economic incentive adopted in late 2011 to increase PD utilization.
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Affiliation(s)
- Annabel Boyer
- Centre Universitaire des Maladies Rénales, CHU de Caen, 14 033 Caen Cedex 9, France.,U1086, INSERM-ANTICIPE-Centre, Régional de Lutte contre, le Cancer, François Baclesse, Caen, France
| | - Antoine Lanot
- Centre Universitaire des Maladies Rénales, CHU de Caen, 14 033 Caen Cedex 9, France.,U1086, INSERM-ANTICIPE-Centre, Régional de Lutte contre, le Cancer, François Baclesse, Caen, France.,Normandie Université, Unicaen, UFR, de médecine, 2 rue des Rochambelles, 14032 Caen Cedex, France
| | - Mark Lambie
- Renal Unit, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.,Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Sonia Guillouet
- Centre Universitaire des Maladies Rénales, CHU de Caen, 14 033 Caen Cedex 9, France.,U1086, INSERM-ANTICIPE-Centre, Régional de Lutte contre, le Cancer, François Baclesse, Caen, France.,Normandie Université, Unicaen, UFR, de médecine, 2 rue des Rochambelles, 14032 Caen Cedex, France
| | - Thierry Lobbedez
- Centre Universitaire des Maladies Rénales, CHU de Caen, 14 033 Caen Cedex 9, France.,U1086, INSERM-ANTICIPE-Centre, Régional de Lutte contre, le Cancer, François Baclesse, Caen, France.,Normandie Université, Unicaen, UFR, de médecine, 2 rue des Rochambelles, 14032 Caen Cedex, France
| | - Clémence Béchade
- Centre Universitaire des Maladies Rénales, CHU de Caen, 14 033 Caen Cedex 9, France.,U1086, INSERM-ANTICIPE-Centre, Régional de Lutte contre, le Cancer, François Baclesse, Caen, France.,Normandie Université, Unicaen, UFR, de médecine, 2 rue des Rochambelles, 14032 Caen Cedex, France
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Lanot A, Bechade C, Boyer A, Ficheux M, Lobbedez T. Assisted peritoneal dialysis and transfer to haemodialysis: a cause-specific analysis with data from the RDPLF. Nephrol Dial Transplant 2020; 36:330-339. [DOI: 10.1093/ndt/gfaa289] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/10/2020] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Technique failure, defined as death or transfer to haemodialysis (HD), is a major concern in peritoneal dialysis (PD). Nurse-assisted PD is globally associated with a lower risk of transfer to HD. We aimed to evaluate the association between assisted PD and the risk of the different causes of transfer to HD.
Methods
This was a retrospective study using data from the French Language PD Registry of patients on incident PD from 2006 to 2015. The association between the use of assisted PD and the causes of transfer to HD was evaluated using survival analysis with competing events in unmatched and propensity score-matched cohorts.
Results
The study included 11 093 incident PD patients treated in 123 French PD units. There were 4273 deaths, 3330 transfers to HD and 2210 renal transplantations. The causes of transfer to HD were inadequate dialysis (1283), infection (524), catheter-related problems (334), social issues (250), other causes linked to PD (422), other causes not linked to PD (481) and encapsulating peritoneal sclerosis (6). Nurse-assisted PD patients were older and more comorbid. Assistance by nurse was associated with a higher risk of death [cause-specific hazard ratio (cs-HR) 2.49, 95% confidence interval (CI) 2.26–2.74], but with a lower risk of transfer to HD [subdistributionHR (sd-HR) 0.68, 95% CI 0.62–0.76], especially due to inadequate dialysis (cs-HR 0.83, 95% CI 0.75–0).
Conclusions
The lower risk of transfer to HD associated with nurse assistance should encourage decision makers to launch reimbursement programmes in countries where it is not available.
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Affiliation(s)
- Antoine Lanot
- Normandie Université, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- “ANTICIPE” U1086 INSERM-UCN, Centre François Baclesse, Caen, France
| | - Clémence Bechade
- Normandie Université, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France
| | - Annabel Boyer
- Normandie Université, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- “ANTICIPE” U1086 INSERM-UCN, Centre François Baclesse, Caen, France
| | - Maxence Ficheux
- Normandie Université, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France
| | - Thierry Lobbedez
- Normandie Université, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- RDPLF, Pontoise, France
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9
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Yin Y, Cao Y, Yuan L. Outcome and Safety of Unplanned-Start Peritoneal Dialysis according to Break-In Periods: A Systematic Review and Meta-Analysis. Blood Purif 2020; 50:161-173. [PMID: 33120399 DOI: 10.1159/000510550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 07/28/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The best timing of peritoneal dialysis (PD) initiation after catheter implantation is still controversial. It is necessary to explore whether there exists a waiting period to minimize the risk of complications. METHODS A systematic review and meta-analysis were searched in multiple electronic databases published from inception to February 29, 2020, to identify cohort studies for evaluating the outcome and safety of unplanned-start PD (<14 days after catheter insertion). Risks of bias across studies were evaluated using Newcastle-Ottawa Quality Assessment Scale. RESULTS Fourteen cohort studies with a total of 2,401 patients were enrolled. We found that early-start PD was associated with higher prevalence of leaks (RR: 2.67, 95% CI, 1.55-4.61) and omental wrap (RR: 3.28, 95% CI, 1.14-9.39). Furthermore, patients of unplanned-start PD in APD group have higher risk of leaks, while those in CAPD group have a higher risk of leaks, omental wrap, and catheter malposition. In shorter break-in period (BI) group, the risk of suffering from catheter obstruction and malposition was higher for patients who started dialysis within 7 days after the surgery than for patients within 7-14 days. No significant differences were found in peritonitis (RR: 1.00; 95% CI, 0.78-1.27) and exit-site infections (RR: 1.12; 95% CI, 0.72-1.75). However, shorter BI was associated with higher risk of mortality and transition to hemodialysis (HD) while worsen early technical survival, with pooled RR of 2.14 (95% CI, 1.52-3.02), 1.42 (95% CI, 1.09-1.85) and 0.95 (95% CI, 0.92-0.99), respectively. CONCLUSIONS Evidence suggests that patients receiving unplanned-start PD may have higher risks of mechanical complications, transition to HD, and even mortality rate while worsening early technical survival, which may not be associated with infectious complications. Rigorous studies are required to be performed.
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Affiliation(s)
- Yiyu Yin
- School of Nursing, Fudan University, Shanghai, China
| | - Yanpei Cao
- Department of Nursing, Huashan Hospital Affiliated to Fudan University, Shanghai, China,
| | - Li Yuan
- Department of Nursing, Huashan Hospital Affiliated to Fudan University, Shanghai, China
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Van Biesen W, Lameire N. Increasing peritoneal dialysis initiation worldwide: ‘there are none so blind as those who will not see’. Nephrol Dial Transplant 2020; 35:1458-1461. [DOI: 10.1093/ndt/gfaa024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 12/28/2019] [Indexed: 01/01/2023] Open
Affiliation(s)
- Wim Van Biesen
- Renal Division, University Hospital Ghent, Ghent, Belgium
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Chan C, Combes G, Davies S, Finkelstein F, Firanek C, Gomez R, Jager KJ, George VJ, Johnson DW, Lambie M, Madero M, Masakane I, McDonald S, Misra M, Mitra S, Moraes T, Nadeau-Fredette AC, Mukhopadhyay P, Perl J, Pisoni R, Robinson B, Ryu DR, Saran R, Sloand J, Sukul N, Tong A, Szeto CC, Van Biesen W. Transition Between Different Renal Replacement Modalities: Gaps in Knowledge and Care-The Integrated Research Initiative. Perit Dial Int 2019; 39:4-12. [PMID: 30692232 DOI: 10.3747/pdi.2017.00242] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/06/2018] [Indexed: 12/27/2022] Open
Abstract
Patients with end-stage kidney disease (ESKD) have different options to replace the function of their failing kidneys. The "integrated care" model considers treatment pathways rather than individual renal replacement therapy (RRT) techniques. In such a paradigm, the optimal strategy to plan and enact transitions between the different modalities is very relevant, but so far, only limited data on transitions have been published. Perspectives of patients, caregivers, and health professionals on the process of transitioning are even less well documented. Available literature suggests that poor coordination causes significant morbidity and mortality.This review briefly provides the background, development, and scope of the INTErnational Group Research Assessing Transition Effects in Dialysis (INTEGRATED) initiative. We summarize the literature on the transition between different RRT modalities. Further, we present an international research plan to quantify the epidemiology and to assess the qualitative aspects of transition between different modalities.
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Affiliation(s)
| | - Christopher Chan
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Gill Combes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Simon Davies
- Institute for Applied Clinical Sciences, Keele University, Keele, UK, and Department of Nephrology, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | | | | | | | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, The Netherlands
| | | | | | - Mark Lambie
- Institute for Applied Clinical Sciences, Keele University, Keele, UK, and Department of Nephrology, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | | | - Ikuto Masakane
- Department of Nephrology, Yabuki Hospital, Yamagata, Japan
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia, and University of Adelaide, Adelaide, Australia
| | - Madhukar Misra
- Department of Medicine, Division of Nephrology, University of Missouri, Columbia, MO, USA
| | - Sandip Mitra
- Nephrology Department, Central Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Thyago Moraes
- Nephrology, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | | | | | - Jeff Perl
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Ronald Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Rajiv Saran
- Division of Nephrology, Department of Medicine & Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - James Sloand
- Renal Division, Baxter Healthcare Corporation, Deerfield, IL, USA
| | - Nidhi Sukul
- Nephrology Department, University of Michigan, Ann Arbor, MI, USA
| | - Allison Tong
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Cheuk-Chun Szeto
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Hassan R, Akbari A, Brown PA, Hiremath S, Brimble KS, Molnar AO. Risk Factors for Unplanned Dialysis Initiation: A Systematic Review of the Literature. Can J Kidney Health Dis 2019; 6:2054358119831684. [PMID: 30899532 PMCID: PMC6419254 DOI: 10.1177/2054358119831684] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/14/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Unplanned dialysis initiation is common in patients with chronic kidney disease (CKD). Objective: To determine common definitions and patient risk factors for unplanned dialysis. Design: Systematic review. Setting: MEDLINE, EMBASE, and the Cochrane Library were searched from inception to February 2018. Patients: Studies that included incident chronic dialysis patients or patients with CKD that cited a definition or examined risk factors for unplanned dialysis were included. Measurements: Definitions and criteria for unplanned dialysis reported across studies. Patient characteristics associated with unplanned dialysis. Methods: Two reviewers independently extracted data using a standardized data abstraction form and assessed study quality using a modified New Castle Ottawa Scale. Results: From 2797 citations, 48 met eligibility criteria. Reported definitions for unplanned dialysis were variable. Most publications cited dialysis initiation under emergency conditions and/or with a central venous catheter. The association of patient characteristics with unplanned dialysis was reported in 26 studies, 18 were retrospective and 21 included incident dialysis patients. The most common risk factors in univariate analyses were (number of studies) increased age (n = 7), cause of kidney disease (n = 6), presence of cardiovascular disease (n = 7), lower serum hemoglobin (n = 9), lower serum albumin (n = 10), higher serum phosphate (n = 6), higher serum creatinine or lower estimated glomerular filtration rate (eGFR) at dialysis initiation (n = 7), late referral (n = 5), lack of dialysis education (n = 6), and lack of follow-up in a predialysis clinic prior to dialysis initiation (n = 5). A minority of studies performed multivariable analyses (n = 10); the most common risk factors were increased age (n = 4), increased comorbidity score (n = 3), late referral (n = 5), and lower eGFR at dialysis initiation (n = 3). Limitations: Comparison of results across studies was limited by inconsistent definitions for unplanned dialysis. High-quality data on patient risk factors for unplanned dialysis are lacking. Conclusions: Well-designed prospective studies to determine modifiable risk factors are needed. The lack of a consensus definition for unplanned dialysis makes research and quality improvement initiatives in this area more challenging.
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Guillouët S, Lobbedez T, Lanot A, Verger C, Ficheux M, Béchade C. Factors associated with nurse assistance among peritoneal dialysis patients: a cohort study from the French Language Peritoneal Dialysis Registry. Nephrol Dial Transplant 2018; 33:1446-1452. [PMID: 29294042 DOI: 10.1093/ndt/gfx338] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 11/09/2017] [Indexed: 11/13/2022] Open
Abstract
Background No information is available regarding nurse-assisted peritoneal dialysis (PD) in non-elderly subjects. This study was carried out to estimate the rate of nurse-assisted PD among non-elderly patients and to assess which individual and centre factors were associated with nurse-assisted PD. The other objective was to estimate the magnitude of the centre effect on the utilization of nurse-assisted PD using hierarchical modelling. Methods This was a retrospective study based on data from the French Language Peritoneal Dialysis Registry. Patients incident on PD > 18 and < 65 years of age were included. Results There were 2269 incidents of PD initiation between January 2008 and December 2012 in 127 PD centres with 114 (5%) on family-assisted PD and 272 (12%) on nurse-assisted PD. At the individual level, compared with autonomous patients, nurse assistance was associated with age {odds ratio [OR] 1.79 [95% confidence interval (CI) 1.51-2.13]}, gender [OR 0.47 (95% CI 0.35-0.64)], comorbidities and underlying nephropathy. There was significant heterogeneity between centres in the nurse assistance utilization (variance of random effect 0.12). At the centre level, the type of centre, centre experience, centre organization and private nurse density were not associated with nurse-assisted PD. Conclusions The rate of nurse-assisted PD among non-elderly patients was 12%. There was a significant centre effect in the utilization of nurse assistance that was not explained by the centres' characteristics. Nurse-assisted PD utilization in non-elderly patients is associated with patient characteristics and also with centre practices.
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Affiliation(s)
- Sonia Guillouët
- Service de Néphrologie, CHU de Caen, Caen Cedex 9, France.,Registre de Dialyse Péritonéale de Langue Française, Pontoise, France
| | - Thierry Lobbedez
- Service de Néphrologie, CHU de Caen, Caen Cedex 9, France.,Registre de Dialyse Péritonéale de Langue Française, Pontoise, France.,Université Caen Normandie-UFR de Médecine (Medical School), Caen Cedex 5, France
| | - Antoine Lanot
- Service de Néphrologie, CHU de Caen, Caen Cedex 9, France.,Université Caen Normandie-UFR de Médecine (Medical School), Caen Cedex 5, France
| | - Christian Verger
- Registre de Dialyse Péritonéale de Langue Française, Pontoise, France
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Étude de l’accès à la liste d’attente de greffe rénale en dialyse péritonéale : intérêt d’une approche avec un modèle de survie comportant une fraction non à risque. Nephrol Ther 2016. [DOI: 10.1016/j.nephro.2016.07.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Guillouët S, Veniez G, Verger C, Béchade C, Ficheux M, Uteza J, Lobbedez T. Estimation of the Center Effect on Early Peritoneal Dialysis Failure: A Multilevel Modelling Approach. Perit Dial Int 2016; 36:519-25. [PMID: 27044794 DOI: 10.3747/pdi.2015.00245] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/29/2015] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ INTRODUCTION This study was carried out to investigate the center effect on the risk of peritoneal dialysis (PD) failure within the first 6 months of therapy using a multilevel approach. ♦ METHODS This was a retrospective cohort study based on data from the French Language Peritoneal Dialysis Registry. We analyzed 5,406 incident patients starting PD between January 2008 and December 2012 in 128 PD centers. The end of the observation period was December 31, 2013. ♦ RESULTS Of the 5,406 patients, 415 stopped PD within the first 6 months. There was a significant heterogeneity between centers (variance of the random effect: 0.10). Only 3% of the variance of the event of interest was attributable to differences between centers. At the individual level, only treatment before PD (odds ratio [OR]: 1.93 for hemodialysis and OR: 2.29 for renal transplantation) and underlying nephropathy (p < 0.01) were associated with early PD failure. At the center level, only center experience was associated (OR: 0.78) with the risk of PD failure. Center effect accounted for 52% of the disparities between centers. ♦ CONCLUSION Center effect on early PD failure is significant. Center experience is associated with a lower risk of transfer to hemodialysis.
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Patients' perceptions of information and education for renal replacement therapy: an independent survey by the European Kidney Patients' Federation on information and support on renal replacement therapy. PLoS One 2014; 9:e103914. [PMID: 25079071 PMCID: PMC4117591 DOI: 10.1371/journal.pone.0103914] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/03/2014] [Indexed: 11/29/2022] Open
Abstract
Background Selection of an appropriate renal replacement modality is of utmost importance for patients with end stage renal disease. Previous studies showed provision of information to and free modality choice by patients to be suboptimal. Therefore, the European Kidney Patients’ Federation (CEAPIR) explored European patients’ perceptions regarding information, education and involvement on the modality selection process. Methods CEAPIR developed a survey, which was disseminated by the national kidney patient organisations in Europe. Results In total, 3867 patients from 36 countries completed the survey. Respondents were either on in-centre haemodialysis (53%) or had a functioning graft (38%) at the time of survey. The majority (78%) evaluated the general information about kidney disease and treatment as helpful, but 39% did not recall being told about alternative treatment options than their current one. Respondents were more often satisfied with information provided on in-centre haemodialysis (90%) and transplantation (87%) than with information provided on peritoneal dialysis (79%) or home haemodialysis (61%), and were more satisfied with information from health care professionals vs other sources such as social media. Most (75%) felt they had been involved in treatment selection, 29% perceived they had no free choice. Involvement in modality selection was associated with enhanced satisfaction with treatment (OR 3.13; 95% CI 2.72–3.60). Many respondents (64%) could not remember receiving education on how to manage their kidney disease in daily life. Perceptions on information seem to differ between countries. Conclusions Kidney patients reported to be overall satisfied with the information they received on their disease and treatment, although information seemed mostly to have been focused on one modality. Patients involved in modality selection were more satisfied with their treatment. However, in the perception of the patients, the freedom to choose an alternative modality showed room for improvement.
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Aydede SK, Komenda P, Djurdjev O, Levin A. Chronic kidney disease and support provided by home care services: a systematic review. BMC Nephrol 2014; 15:118. [PMID: 25033891 PMCID: PMC4127071 DOI: 10.1186/1471-2369-15-118] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 06/19/2014] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Chronic diseases, such as chronic kidney disease (CKD), are growing in incidence and prevalence, in part due to an aging population. Support provided through home care services may be useful in attaining a more efficient and higher quality care for CKD patients. METHODS A systematic review was performed to identify studies examining home care interventions among adult CKD patients incorporating all outcomes. Studies examining home care services as an alternative to acute, post-acute or hospice care and those for long-term maintenance in patients' homes were included. Studies with only a home training intervention and those without an applied research component were excluded. RESULTS Seventeen studies (10 cohort, 4 non-comparative, 2 cross-sectional, 1 randomized) examined the support provided by home care services in 15,058 CKD patients. Fourteen studies included peritoneal dialysis (PD), two incorporated hemodialysis (HD) and one included both PD and HD patients in their treatment groups. Sixteen studies focused on the dialysis phase of care in their study samples and one study included information from both the dialysis and pre-dialysis phases of care. Study settings included nine single hospital/dialysis centers and three regional/metropolitan areas and five were at the national level. Studies primarily focused on nurse assisted home care patients and mostly examined PD related clinical outcomes. In PD studies with comparators, peritonitis risks and technique survival rates were similar across home care assisted patients and comparators. The risk of mortality, however, was higher for home care assisted PD patients. While most studies adjusted for age and comorbidities, information about multidimensional prognostic indices that take into account physical, psychological, cognitive, functional and social factors among CKD patients was not easily available. CONCLUSIONS Most studies focused on nurse assisted home care patients on dialysis. The majority were single site studies incorporating small patient populations. There are gaps in the literature regarding the utility of providing home care to CKD patients and the impact this has on healthcare resources.
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Affiliation(s)
- Sema K Aydede
- School of Population and Public Health, The University of British Columbia and Provincial Health Services Authority, 700-1380 Burrard Street, Vancouver, BC V6Z 2H3, Canada
| | - Paul Komenda
- Faculty of Medicine, Section of Nephrology, University of Manitoba and Seven Oaks General Hospital, Room 2PD02 – 2300 McPhillips Street, Winnipeg, MB R2V 3M3, Canada
| | - Ognjenka Djurdjev
- British Columbia Provincial Renal Agency, Providence Bldg, Room 570.4, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Adeera Levin
- Division of Nephrology, Providence Bldg, Room 6010A, The University of British Columbia and British Columbia Provincial Renal Agency, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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Ivarsen P, Povlsen JV. Can peritoneal dialysis be applied for unplanned initiation of chronic dialysis? Nephrol Dial Transplant 2013; 29:2201-6. [PMID: 24353321 DOI: 10.1093/ndt/gft487] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Late referral of patients with chronic kidney disease (CKD) and unforeseeable deterioration of residual renal function in known CKD patients remain a major problem leading to the need of unplanned start on chronic dialysis without a mature access for dialysis. In most centres worldwide, these patients are started on haemodialysis (HD) using a temporary tunnelled central venous catheter (CVC) for access. However, during the last decade, increasing clinical experience with unplanned start on peritoneal dialysis (PD) right after PD catheter implantation has been published. Key studies are reviewed in the present paper, and the results seem to indicate that compared with patients starting PD in a planned setting with peritoneal resting after PD catheter implantation, patients starting unplanned PD have an increased risk of mechanical complications but apparently no increased risk of infectious complications. In contrast, patients starting unplanned HD using a temporary CVC have an increased risk of both mechanical and infectious complications when compared with patients starting planned HD using an arterio-venous fistula or a permanent CVC. Regarding clinical outcome in terms of survival, unplanned PD seems to be at least as safe as unplanned HD. Combining the unplanned PD programme with a nurse-assisted PD programme is crucial in order to offer the patient a real opportunity to choose a home-based dialysis option. In conclusion, unplanned start on PD seems to be a feasible, safe and efficient alternative to unplanned start on HD for the late referred patient with end-stage renal disease and urgent need for dialysis.
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Affiliation(s)
- Per Ivarsen
- Department of Renal Medicine, Aarhus University Hospital and Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Johan V Povlsen
- Department of Renal Medicine, Aarhus University Hospital and Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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Nessim SJ, Bargman JM, Jassal SV, Oliver MJ, Na Y, Perl J. The impact of transfer from hemodialysis on peritoneal dialysis technique survival. Perit Dial Int 2013; 35:297-305. [PMID: 24293665 DOI: 10.3747/pdi.2013.00147] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 10/20/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A significant proportion of peritoneal dialysis (PD) patients receive an initial period of hemodialysis (HD) before transitioning to PD ("PD-switch"). We sought to better understand the risks of PD technique failure (TF) and mortality for those patients compared with patients starting with PD as their first dialysis modality ("PD-first"). METHODS Using Canadian Organ Replacement Register data, we compared the risk of PD TF between PD-first and PD-switch patients within the first year after HD initiation. In a secondary analysis, the PD-switch patients were stratified into three groups based on timing of the switch from initial HD to PD as follows: 0 - 90 days, 91 - 180 days, and 181 - 365 days. Each group was compared with PD-first patients for risk of PD TF and death. RESULTS Between 2001 and 2010, 9404 patients initiated PD as their first renal replacement therapy, and 3757 switched from HD to PD. After multivariable adjustment, the risk of PD TF was higher among PD-switch patients than among PD-first patients [adjusted hazard ratio (AHR): 1.37; 95% confidence interval (CI): 1.26 to 1.49], particularly within the first year after the switch from HD to PD (AHR: 1.51; 95% CI: 1.36 to 1.68). There was no association between time on HD within the first year and subsequent risk of PD TF. For all the stratified PD-switch groups, death rates were higher than those for PD-first patients. CONCLUSIONS Compared with patients who start renal replacement therapy with PD, those who transfer from HD to PD within the first year on dialysis experience higher rates of PD TF and death, with the highest risk being observed in the initial year after the switch to PD.
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Affiliation(s)
- Sharon J Nessim
- Division of Nephrology, Jewish General Hospital, McGill University, Montreal, Quebec
| | - Joanne M Bargman
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - S Vanita Jassal
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Matthew J Oliver
- Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Yingbo Na
- Canadian Institute of Health Information and The Canadian Organ Replacement Register, Toronto, Ontario, Canada
| | - Jeffrey Perl
- Division of Nephrology and The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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