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Danneville I, Beaumier M, Boyer A, Chatelet V, Monnet E, Edet S, Lanot A, Bechade C, Lobbedez T. Sex disparities in the utilization of nurse-assisted peritoneal dialysis: a mediation analysis using data from the REIN registry. Clin Kidney J 2024; 17:sfad301. [PMID: 38213499 PMCID: PMC10783235 DOI: 10.1093/ckj/sfad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Indexed: 01/13/2024] Open
Abstract
Background This study was carried out to evaluate the association between patient sex and the proportion of nurse-assisted peritoneal dialysis (PD) at dialysis initiation and to explore whether sex disparities in nurse-assisted PD utilization was explained by predialysis care and/or by social deprivation using mediation analysis. Methods This was a retrospective study using data from the Renal Epidemiology and Information Network (REIN) registry linked to the French National Healthcare Database (SNDS) of incident patients between 1 January 2017 and 30 June 2018. A regression logistic was used for statistical analysis. A mediation analysis explored the direct effect of sex on nurse-assisted PD proportion and the indirect effect through the European Deprivation Index (EDI), and the number of general practitioner (GP) and nephrologist visits before dialysis initiation. Results Among 1706 patients on PD, there were 637 women (37.3%) and 1069 men (62.7%). Nurse-assisted PD proportion was 332/610 (54.4%) for women vs 464/1036 (44.8%) for men. In the multivariable analysis women were more likely to be treated by nurse-assisted PD {odds ratio (OR) 1.92 [95% confidence interval (CI) 1.46-2.52]}. Nurse-assisted PD was associated with the median number of GP visits [OR 1.44 (95% CI 1.11-1.86)] and with the median number of nephrologist visits [OR 0.59 (95% CI 0.46-0.76)]. The mediation analysis showed a direct effect of sex on nurse-assisted PD [OR 1.90 (95% CI 1.80-2.01)] and an indirect effect through the median number of GP visits [OR 1.05 (95% CI 1.04-1.06], the median number of nephrologist visits [OR 1.02 (95% CI 1.02-1.03)] and quintile 5 of the EDI [OR 1.03 (95% CI 1.02-1.03)]. Conclusion Women were more frequently treated by nurse-assisted PD than men. Differences between women and men in predialysis care and social deprivation could explain the greater utilization of nurse-assisted PD among women.
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Affiliation(s)
- Isabelle Danneville
- CHU de Caen Normandie, Centre Universitaire des Maladies Rénales, Caen, France
| | - Mathilde Beaumier
- CHU de Caen Normandie, Centre Universitaire des Maladies Rénales, Caen, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- «ANTICIPE», U1086 Inserm-UCN, Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Annabel Boyer
- CHU de Caen Normandie, Centre Universitaire des Maladies Rénales, Caen, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- «ANTICIPE», U1086 Inserm-UCN, Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Valérie Chatelet
- CHU de Caen Normandie, Centre Universitaire des Maladies Rénales, Caen, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- «ANTICIPE», U1086 Inserm-UCN, Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Elisabeth Monnet
- CIC-1431 INSERM, CHU Besançon, Université de Franche-Comté, Besançon Cedex, France
| | - Stéphane Edet
- Department of Nephrology and Haemodialysis, Rouen University Hospital, France – ANIDER Rouen Normandie, Rouen, France
| | - Antoine Lanot
- CHU de Caen Normandie, Centre Universitaire des Maladies Rénales, Caen, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- «ANTICIPE», U1086 Inserm-UCN, Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Clémence Bechade
- CHU de Caen Normandie, Centre Universitaire des Maladies Rénales, Caen, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- «ANTICIPE», U1086 Inserm-UCN, Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Thierry Lobbedez
- CHU de Caen Normandie, Centre Universitaire des Maladies Rénales, Caen, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- «ANTICIPE», U1086 Inserm-UCN, Centre de Lutte Contre le Cancer François Baclesse, Caen, France
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2
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Gursu M, Shehaj L, Elcioglu OC, Kazancioglu R. The optimization of peritoneal dialysis training in long-term. FRONTIERS IN NEPHROLOGY 2023; 3:1108030. [PMID: 37675347 PMCID: PMC10479566 DOI: 10.3389/fneph.2023.1108030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/20/2023] [Indexed: 09/08/2023]
Abstract
Peritoneal dialysis is a home based therapy for patients with advanced chronic kidney disease. This method provides adequate clearance of uremic toxins and removal of excess fluid when a proper dialysis prescription is combined with patient adherence. Peritonitis is the most frequent infectious complication among these patients and may render the continuity of the treatment. Training patients and their caregivers have prime importance to provide proper treatment and prevent complications including infectious ones. The training methods before the onset of treatment are relatively well established. However, patients may break the rules in the long term and tend to take shortcuts. So, retraining may be necessary during follow-up. There are no established guidelines to guide the retraining of PD patients yet. This review tends to summarize data in the literature about retraining programs and also proposes a structured program for this purpose.
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Affiliation(s)
- Meltem Gursu
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
| | - Larisa Shehaj
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
- Department of Internal Medicine, Salus Hospital, Tirana, Albania
- ISN fellow in Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
| | - Omer Celal Elcioglu
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
| | - Rumeyza Kazancioglu
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
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3
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Damanti S, Cristel G, Ramirez GA, Bozzolo EP, Da Prat V, Gobbi A, Centurioni C, Di Gaeta E, Del Prete A, Calabrò MG, Calvi MR, Borghi G, Zangrillo A, De Cobelli F, Landoni G, Tresoldi M. Influence of reduced muscle mass and quality on ventilator weaning and complications during intensive care unit stay in COVID-19 patients. Clin Nutr 2022; 41:2965-2972. [PMID: 34465493 PMCID: PMC8364854 DOI: 10.1016/j.clnu.2021.08.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Sarcopenia, a loss of muscle mass, quality and function, which is particularly evident in respiratory muscles, has been associated with many clinical adverse outcomes. In this study, we aimed at evaluating the role of reduced muscle mass and quality in predicting ventilation weaning, complications, length of intensive care unit (ICU) and of hospital stay and mortality in patients admitted to ICU for SARS-CoV-2-related pneumonia. METHODS This was an observational study based on a review of medical records of all adult patients admitted to the ICU of a tertiary hospital in Milan and intubated for SARS-CoV-2-related pneumonia during the first wave of the COVID-19 pandemic. Muscle mass and quality measurement were retrieved from routine thoracic CT scans, when sections passing through the first, second or third lumbar vertebra were available. RESULTS A total of 81 patients were enrolled. Muscle mass was associated with successful extubation (OR 1.02, 95% C.I. 1.00-1.03, p = 0.017), shorter ICU stay (OR 0.97, 95% C.I. 0.95-0.99, p = 0.03) and decreased hospital mortality (HR 0.98, 95% C.I. 0.96-0.99, p = 0.02). Muscle density was associated with successful extubation (OR 1.07, 95% C.I. 1.01-1.14; p = 0.02) and had an inverse association with the number of complications in ICU (Β -0.07, 95% C.I. -0.13 - -0.002, p = 0.03), length of hospitalization (Β -1.36, 95% C.I. -2.21 - -0.51, p = 0.002) and in-hospital mortality (HR 0.88, 95% C.I. 0.78-0.99, p = 0.046). CONCLUSIONS Leveraging routine CT imaging to measure muscle mass and quality might constitute a simple, inexpensive and powerful tool to predict survival and disease course in patients with COVID-19. Preserving muscle mass during hospitalisation might have an adjuvant role in facilitating remission from COVID-19.
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Affiliation(s)
- Sarah Damanti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Italy,Corresponding author. Unit of General Medicine and Advanced Care, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, Italy
| | - Giulia Cristel
- Department of Radiology, Centre for Experimental Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Alvise Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrica Paola Bozzolo
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Italy
| | - Valentina Da Prat
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Italy
| | - Agnese Gobbi
- Vita-Salute San Raffaele University, Milano, Italy
| | | | - Ettore Di Gaeta
- Department of Radiology, Centre for Experimental Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy,Vita-Salute San Raffaele University, Milano, Italy
| | - Andrea Del Prete
- Department of Radiology, Centre for Experimental Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy,Vita-Salute San Raffaele University, Milano, Italy
| | - Maria Grazia Calabrò
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Rosa Calvi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Borghi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Vita-Salute San Raffaele University, Milano, Italy,Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, Centre for Experimental Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Vita-Salute San Raffaele University, Milano, Italy,Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Italy
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Jiang C, Zheng Q. Outcomes of peritoneal dialysis in elderly vs non-elderly patients: A systemic review and meta-analysis. PLoS One 2022; 17:e0263534. [PMID: 35134073 PMCID: PMC8824377 DOI: 10.1371/journal.pone.0263534] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/21/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives Several studies have compared outcomes of peritoneal dialysis (PD) between elderly and non-elderly patients but with variable results. We hereby designed this review to compare mortality, peritonitis, and technique survival between elderly and non-elderly patients on PD. Methods PubMed, Embase, and Google Scholar were searched for studies comparing outcomes of PD between elderly and non-elderly patients. The last search date was 14th July 2021. Results Fourteen studies were included. 12 studies defined the elderly as ≥65 years of age and these were included in the meta-analysis. Pooled analysis of crude (RR: 2.45 95% CI: 1.36, 4.40 I2 = 97% p = 0.003) and adjusted data (HR: 2.80 95% CI: 2.45, 3.09 I2 = 0% p<0.00001) indicated a statistically significant increased risk of mortality amongst elderly patients as compared to non-elderly patients. Meta-analysis of four studies demonstrated a statistically significant increased risk of peritonitis in the elderly (RR: 1.56 95% CI: 1.18, 2.07 I2 = 76% p = 0.002). Pooled analysis demonstrated no statistically significant difference in technique survival between the two groups (RR: 0.95 95% CI: 0.86, 1.05 I2 = 86% p = 0.32). Conclusion Elderly patients on PD have a significantly increased risk of mortality as compared to non-elderly patients. The risk of peritonitis is also significantly increased in older adults but the increased age has no impact on technique survival. Further studies are needed to strengthen our conclusions.
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Affiliation(s)
- Chunling Jiang
- Department of nephrology, The affiliated People’s Hospital with Jiangsu University, Zhenjiang, Jiangsu, P.R.China
- * E-mail:
| | - Qiang Zheng
- Department of nephrology, The affiliated People’s Hospital with Jiangsu University, Zhenjiang, Jiangsu, P.R.China
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Béchade C, Lanot A, Guillouët S, Ficheux M, Boyer A, Lobbedez T. Impact of assistance on peritonitis due to breach in aseptic procedure in diabetic patients: A cohort study with the RDPLF data. Perit Dial Int 2021; 42:185-193. [PMID: 34514906 DOI: 10.1177/08968608211039669] [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: 11/17/2022] Open
Abstract
BACKGROUND Diabetic patients often have physical impairment that could lead to manipulation errors in peritoneal dialysis (PD) and touch contamination. Nurse assistance in diabetic PD patients is known to help prevent peritonitis. We made the hypothesis that this lower risk of peritonitis was observed thanks to prevention of breach in aseptic procedure. We evaluated the impact of nurse-assisted PD on specific causes of peritonitis, especially on peritonitis due to a breach in aseptic procedure. METHODS This was a retrospective observational study of the data from the French Language Peritoneal Dialysis Registry. All diabetic patients older than age 18 years starting PD in France between 1 January 2012 and 31 December 2015 were included in the study. The event of interest was the first peritonitis event due to a breach in aseptic procedure. Death, kidney transplantation and peritonitis due to another mechanism were considered as competing events. We examined the association of the covariates with all the possible outcomes using a subdistribution hazard model developed for survival analysis in the presence of competing risks. RESULTS Four thousand one hundred one diabetic patients incident in PD were included in the study. At least one peritonitis event occurred in 1611 patients over the study period. A breach in aseptic procedure was reported in 441/1611 cases (27.3%): 209/575 (36.3%) in the self-care PD group, 56/217 (25.8%) in the family-assisted PD group and 176/819 (21.5%) in the nurse-assisted PD group. Both nurse and family assistance were associated with a lower risk of peritonitis due to breach in aseptic procedure in bivariate analysis. After adjustment on age, modified Charlson index, sex and diabetic nephropathy, patients treated by nurse-assisted PD (subdistribution hazard ratio (sd-HR) 0.52, 95% confidence interval (CI) 0.40-0.67) and those treated by family-assisted PD (sd-HR 0.70, 95% CI 0.51-0.95) had a lower likelihood of peritonitis due to a connection error compared to self-care PD in multivariate analysis. The modality of assistance was not associated with other causes of peritonitis in the multivariate analysis. CONCLUSION While both nurse-assisted PD and family-assisted PD were associated with lower risk of peritonitis due to a breach in aseptic procedure compared to self-care PD in our study, the protective effect was greater with nurse assistance.
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Affiliation(s)
- Clémence Béchade
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France.,"ANTICIPE" U1086 INSERM-UCN, Centre François Baclesse, Caen, France
| | - Antoine Lanot
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France.,"ANTICIPE" U1086 INSERM-UCN, Centre François Baclesse, Caen, France
| | - Sonia Guillouët
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France
| | - Maxence Ficheux
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France
| | - Annabel Boyer
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France
| | - Thierry Lobbedez
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France.,"ANTICIPE" U1086 INSERM-UCN, Centre François Baclesse, Caen, France
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6
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Song Q, Yan H, Yu Z, Li Z, Yuan J, Ni Z, Fang W. Assisted peritoneal dialysis: a feasible KRT modality for frail older patients with end-stage kidney disease (ESKD). Sci Rep 2021; 11:14928. [PMID: 34294768 PMCID: PMC8298431 DOI: 10.1038/s41598-021-94032-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/05/2021] [Indexed: 11/09/2022] Open
Abstract
Assisted PD is used as an alternative option for the growing group of frail, older ESKD patients unable to perform their own PD. This study was undertaken to investigate the outcomes of assisted PD in older patients by comparing assisted PD patients with self-care PD patients. This study included all patients aged 70 and above who started on PD in our hospital from 2009 to 2018. Patients were followed up until death, PD cessation or to the end of the study (December 31, 2019). Risk factors associated with mortality, peritonitis and technique failure were evaluated using both cause-specific hazards and subdistribution hazards models. 180 patients were enrolled, including 106 (58.9%) males with a median age of 77.5 (77.2-81.2) years. Among the 180 patients, 62 patients (34.4%) were assisted. Patients on assisted PD group were older, more likely to be female, more prevalent in DM and CVD, with a higher Charlson score than patients undergoing self-care PD (P all < 0.05). In the multivariable analysis, assisted patients had a comparable patient survival and peritonitis-free survival compared to self-care PD patients either in the Cox or in the FG models. According to a Cox model, the use of assisted PD was associated with a lower risk of technique failure (cs-HR 0.20, 95% CI 0.04-0.76), but the association lost its statistical significance in the Fine and Gray model. Our results suggest that assisted PD could be a safe and effective KRT modality for older ESKD patients who need assistance.
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Affiliation(s)
- Qianhui Song
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People's Republic of China.,Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Hao Yan
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People's Republic of China.,Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Zanzhe Yu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People's Republic of China.,Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Zhenyuan Li
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People's Republic of China.,Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Jiangzi Yuan
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People's Republic of China.,Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Zhaohui Ni
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People's Republic of China.,Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Wei Fang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People's Republic of China. .,Shanghai Center for Peritoneal Dialysis Research, Shanghai, China.
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7
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Jiang X, Wang Y, Xiao A, Feng S. Patients undergoing assisted peritoneal dialysis to show a better technique survival: A competing risk analysis. Int J Clin Pract 2021; 75:e14192. [PMID: 33792114 DOI: 10.1111/ijcp.14192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/27/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS To compare patient mortality and technique survival between patients undergoing assisted peritoneal dialysis (aPD) and self-care peritoneal dialysis (sPD). METHODS Patients who underwent peritoneal dialysis (PD) at the dialysis center of Second Affiliated Hospital of Soochow University from January 1, 2012 to December 31, 2016, were included and followed to December 31, 2019. Subjects were divided into aPD and sPD groups according to whether the patient could independently complete the PD procedure. Differences in mortality and technique failure rates were compared using competing risk analysis. RESULTS A total of 384 patients were included in this study, with 274 patients in the sPD group and 110 patients in the aPD group. The multivariate competing risk regression analysis revealed that age (HR 1.03,95%CI 1.01-1.05, P < .001), aPD (HR 1.84,95%CI 1.10-3.08, P = .02), diabetes (HR 1.51, 95%CI 1.00-2.30, P = .05), residual renal function (HR 0.89, 95%CI 0.82-0.97, P = .005) and serum albumin level (HR 0.92, 95% CI 0.89-0.96, P < .001) were the independent risk factors for mortality. Besides, technique failure in aPD patients was lower than in the sPD group (HR 0.85, 95% CI 0.68-0.97, P = .03). CONCLUSION These results found that aPD patients had higher mortality rates but lower technique failure rates than sPD patients. Higher mortality in aPD is probably related to the negative selection of the more comorbid patients. .
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Affiliation(s)
- Xiaomei Jiang
- Department of Nursing, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yun Wang
- Department of Nursing, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Aihua Xiao
- Department of Nursing, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Sheng Feng
- Department of Nephrology, Second Affiliated Hospital of Soochow University, Suzhou, China
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8
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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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Fox DE, Quinn RR, James MT, Venturato L, King-Shier KM. Social Support in the Peritoneal Dialysis Experience: A Qualitative Descriptive Study. Can J Kidney Health Dis 2020; 7:2054358120946572. [PMID: 32843986 PMCID: PMC7418238 DOI: 10.1177/2054358120946572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 06/11/2020] [Indexed: 11/30/2022] Open
Abstract
Background: People with end-stage kidney disease can either pursue conservative (palliative) management or kidney replacement therapy. Although transplant is preferred, there is a limited number of organs available rendering the majority of patients treated with some form of dialysis. Hemodialysis and peritoneal dialysis are equivalent regarding clinical outcomes, but peritoneal dialysis is much less costly to provide. Peritoneal dialysis is most often done in the home by the patient or a support person and carries a self-care burden on patients and families. Social support is important for patients receiving peritoneal dialysis and in sustaining peritoneal dialysis therapy. Few studies have comprehensively explored social support in the context of peritoneal dialysis. Objective: To explore how patients, family members, and nurses view social support. Design: Qualitative, descriptive study. Setting: An outpatient peritoneal dialysis clinic in Western Canada. Participants: Patients, family members, and nurses. Methods: Patients (n = 15), family members (n = 6), and nurses (n = 11) were interviewed between January and May 2018. Content analysis was undertaken using 4 attributes of social support (ie, emotional support, instrumental support, informational support, and appraisal support) as an analytic framework. Results: Themes related to the 4 attributes of social support were identified: addressing emotional needs and managing emotion (emotional support); peritoneal dialysis tasks and life tasks (instrumental support); accessing information, receiving information, and learning (informational support); and affirmation/external reassurance and self-confidence (appraisal support). The social support needs of both patients and family members varied and were dependent on their existing support networks and individual perspectives of support. Limitations: It is possible that some of the study findings were gender-bound as well as context-specific. The study findings could be different if the patient and caregiver sample were more balanced based on sex. There are also unique attributes of each peritoneal dialysis program that may impact the transferability of these findings to other practice settings. Conclusion: Home-based peritoneal dialysis has potential benefit to patients and health care systems. However, receiving peritoneal dialysis requires support. If health care providers wish to promote this treatment, they must also understand how to best support patients and their family members. Trial Registration: Not applicable.
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Affiliation(s)
| | - Robert R Quinn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Matthew T James
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | | | - Kathryn M King-Shier
- Faculty of Nursing, University of Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
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10
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Hofmeister M, Klarenbach S, Soril L, Scott-Douglas N, Clement F. A Systematic Review and Jurisdictional Scan of the Evidence Characterizing and Evaluating Assisted Peritoneal Dialysis Models. Clin J Am Soc Nephrol 2020; 15:511-520. [PMID: 32188636 PMCID: PMC7133129 DOI: 10.2215/cjn.11951019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/20/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Compared with hemodialysis, home peritoneal dialysis alleviates the burden of travel, facilitates independence, and is less costly. Physical, cognitive, or psychosocial factors may preclude peritoneal dialysis in otherwise eligible patients. Assisted peritoneal dialysis, where trained personnel assist with home peritoneal dialysis, may be an option, but the optimal model is unknown. The objective of this work is to characterize existing assisted peritoneal dialysis models and synthesize clinical outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A systematic review of MEDLINE, Cochrane Central Register of Controlled Trails, Cochrane Database of Systematic Reviews, Embase, PsycINFO, and CINAHL was conducted (search dates: January 1995-September 2018). A focused gray literature search was also completed, limited to developed nations. Included studies focused on home-based assisted peritoneal dialysis; studies with the assist provided exclusively by unpaid family caregivers were excluded. All outcomes were narratively synthesized; quantitative outcomes were graphically depicted. RESULTS We included 34 studies, totaling 46,597 patients, with assisted peritoneal dialysis programs identified in 20 jurisdictions. Two categories emerged for models of assisted peritoneal dialysis on the basis of type of assistance: health care and non-health care professional assistance. Reported outcomes were heterogeneous, ranging from patient-level outcomes of survival, to resource use and transfer to hemodialysis; however, the comparative effect of assisted peritoneal dialysis was unclear. In two qualitative studies examining the patient experience, the maintenance of independence was identified as an important theme. CONCLUSIONS Reported outcomes and quality were heterogeneous, and relative efficacy of assisted peritoneal dialysis could not be determined from included studies. Although the patient voice was under-represented, suggestions to improve assisted peritoneal dialysis included using a person-centered model of care, ensuring continuity of nurses providing the peritoneal dialysis assist, and measures to support patient independence. Although attractive elements of assisted peritoneal dialysis are identified, further evidence is needed to connect assisted peritoneal dialysis outcomes with programmatic features and their associated funding models.
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Affiliation(s)
- Mark Hofmeister
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Scott Klarenbach
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lesley Soril
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | | | - Fiona Clement
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; .,Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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11
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Evaluation of the association between decreased skeletal muscle mass and extubation failure after long-term mechanical ventilation. Clin Nutr 2019; 39:2764-2770. [PMID: 31917051 DOI: 10.1016/j.clnu.2019.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/26/2019] [Accepted: 12/02/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Elderly patients are being increasingly admitted to the intensive care unit (ICU) for mechanical ventilation (MV) and prevalence of decreased skeletal muscle mass which develop with aging is subsequently increasing. The objective of this study was to identify the association between decreased skeletal muscle mass and extubation failure in patients undergoing long-term MV. METHODS Adults (≥18 years of age) with long-term MV for > 7 days between January 2014 and February 2019 were included retrospectively. Patients who died or were transferred with MV, underwent tracheostomy with failure of weaning from MV, and had not undergone abdominal computed tomography within 3 days before or after intubation were excluded. Failed extubation was defined as reintubation within 48 h after extubation following long-term MV for >7 days. We divided the patients into extubation success and failure groups. RESULTS Parameters including patients' demographics, cause of intubation, initial setting of MV, maximum inspiratory pressure (MIP) and rapid shallow breath index (RSBI) at extubation, and skeletal muscle mass were compared between the two groups. Decreased skeletal muscle mass was set a standard as a L3 muscle index of less than 49 cm2/m2 for men and of less than 31 cm2/m2 for women using Korean-specific cut-offs for sarcopenia as evaluated on previous epidemiologic study. Among 104 patients who were screened, 45 were included, and 11 (24.4%) failed to be extubated. Mean MIP (23.5 ± 11.8 vs. 32.4 ± 9.3, p = 0.134) and RSBI (57.2 ± 26.5 vs. 55.3 ± 20.4, p = 0.803) were not different between the two groups. The proportions of patients whose MIP or RSBI satisfied the cutoff for extubation were not different between the groups. There were no significant differences in age, sex, body mass index, comorbidities, nutritional status, and cause of intubation between the two groups. The extubation failure group showed a higher proportion of decreased skeletal muscle mass (90.9% vs. 58.8%, p = 0.05) and longer duration of MV (10.7 ± 4.1 vs. 9.6 ± 3.4, p < 0.001) than the extubation success group. Multivariate analysis showed that the duration of intubation (OR = 1.439, 95% CI = 1.12-1.85), and decreased skeletal muscle mass (OR = 24.382, 95% CI = 1.00-594.86) were associated with extubation failure. CONCLUSIONS Decreased skeletal muscle mass was associated with extubation failure after long-term MV for > 7 days. It is important to diagnose decreased skeletal muscle mass in critically ill patients to reduce extubation failure rates.
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12
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Pungchompoo W, Parinyajittha S, Pungchompoo S, Kumtan P. Effectiveness of a self‐management retraining program improving the quality of life of people receiving continuous ambulatory peritoneal dialysis. Nurs Health Sci 2019; 22:406-415. [DOI: 10.1111/nhs.12672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 10/28/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Wanicha Pungchompoo
- Department of Medical NursingFaculty of Nursing, Chiang Mai University Chiang Mai Thailand
| | | | - Sirirat Pungchompoo
- Department of Chemical Engineering, Faculty of EngineerRajamangala University of Technology Srivijaya Songkhla Thailand
| | - Paweena Kumtan
- Department of NephrologyFaculty of Medicine, Chiang Mai University Chiang Mai Thailand
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13
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Tennankore K, Zhao J, Karaboyas A, Bieber BA, Robinson BM, Morgenstern H, Jassal SV, Finkelstein FO, Kanjanabuch T, Cheawchanwattana A, Pisoni RL, Sloand JA, Perl J. The Association of Functional Status with Mortality and Dialysis Modality Change: Results from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Perit Dial Int 2019; 39:103-111. [PMID: 30739094 DOI: 10.3747/pdi.2018.00094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 11/14/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Little is known about the prevalence of functional impairment in peritoneal dialysis (PD) patients, its variation by country, and its association with mortality or transfer to hemodialysis. METHODS A prospective cohort study was conducted in PD patients from 7 countries in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) (2014 - 2017). Functional status (FS) was assessed by combining self-reports of 8 instrumental and 5 basic activities of daily living, using the Lawton-Brody and the Katz questionnaires. Summary FS scores, ranging from 1.25 (most dependent) to 13 (independent), were based on the patient's ability to perform each activity with or without assistance. Logistic regression was used to estimate the odds ratio (OR; 95% confidence interval [CI]) of a FS score < 11 comparing each country with the United States (US). Cox regression was used to estimate the hazard ratio (HR; 95% CI) for the effect of a low FS score on mortality and transfer to hemodialysis, adjusting for case mix. RESULTS Of 2,593 patients with complete data on FS, 48% were fully independent (FS = 13), 32% had a FS score 11 to < 13, 14% had a FS score 8 to < 11, and 6% had a FS score < 8. Relative to the US, low FS scores (< 11; more dependent) were more frequent in Thailand (OR = 10.48, 5.90 - 18.60) and the United Kingdom (UK) (OR = 3.29, 1.77 - 6.08), but similar in other PDOPPS countries. The FS score was inversely and monotonically associated with mortality but not with transfer to hemodialysis; the HR, comparing a FS score < 8 vs 13, was 4.01 (2.44 - 6.61) for mortality and 0.91 (0.58 - 1.43) for transfer to hemodialysis. CONCLUSION Regional differences in FS scores observed across PDOPPS countries may have been partly due to differences in regional patient selection for PD. Functional impairment was associated with mortality but not with permanent transfer to hemodialysis.
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Affiliation(s)
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - Hal Morgenstern
- Departments of Epidemiology and Environmental Health Sciences, School of Public Health, and Department of Urology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - S Vanita Jassal
- Division of Nephrology, University Health Network, Toronto, ON, Canada
| | | | - Talerngsak Kanjanabuch
- Kidney and Metabolic Research Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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14
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Lai S, Amabile MI, Bargagli MB, Musto TG, Martinez A, Testorio M, Mastroluca D, Lai C, Aceto P, Molfino A. Peritoneal dialysis in older adults: Evaluation of clinical, nutritional, metabolic outcomes, and quality of life. Medicine (Baltimore) 2018; 97:e11953. [PMID: 30170391 PMCID: PMC6393061 DOI: 10.1097/md.0000000000011953] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 07/26/2018] [Indexed: 11/26/2022] Open
Abstract
The number of older adults requiring dialysis is increasing worldwide, whereas the use of peritoneal dialysis (PD) in this population is lower with respect to younger patients, despite the theoretical advantages of PD respect to hemodialysis. This is most likely due to the concern that older patients may not be able to correctly and safely manage PD.We aimed to prospectively compare clinical, nutritional and metabolic outcomes and measures of quality of life between younger (<65 years old) and older (≥65 years old) patients on PD.PD patients were enrolled and divided into 2 groups according to age (Group A < 65 years, Group B ≥ 65 years). Clinical and instrumental parameters, and quality of life were evaluated at baseline (start of PD) (T0) and at 24 months (T1). Technique survival, mortality, total number of hospitalizations, and the index of peritonitis (episodes of peritonitis/month) were also evaluated.Fifty-one patients starting PD were enrolled. Group A included 22 patients (48.7 ± 8.3 years), and Group B consisted of 29 patients (74.1 ± 6.4 years). At baseline, the 2 groups showed no differences in cognitive status, whereas Group A showed higher total cholesterol (P = .03), LDL (P = .03), and triglycerides (P = .03) levels and lower body mass index (P = .02) and carotid intima media thickness (P < .0001) with respect to Group B. At T1 Group B showed, compared to baseline, a significant reduction in albumin (P < .0001) and phosphorus (P = .045) levels, while no significant differences on body composition, technique survival, total number of hospitalizations, index of peritonitis, and quality of life indices were observed.Our data do not show clinically relevant barriers to use PD in older adult patients, supporting its use in this population. Nutritional and metabolic parameters should be carefully monitored in older PD patients.
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Affiliation(s)
- Silvia Lai
- Department of Clinical Medicine, Sapienza University of Rome
| | | | | | - T. Gnerre Musto
- Department of Obstetrical-GynecologicalSciences and Urologic Sciences
| | - Andrea Martinez
- Department of Obstetrical-GynecologicalSciences and Urologic Sciences
| | - Massimo Testorio
- Department of Obstetrical-GynecologicalSciences and Urologic Sciences
| | | | - Carlo Lai
- Department of Dynamic and Clinic Psychology, Sapienza University of Rome
| | - Paola Aceto
- Department of Anaesthesia and Intensive care,Catholic University of Sacred Heart, Rome, Italy
| | - Alessio Molfino
- Department of Clinical Medicine, Sapienza University of Rome
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15
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Bevilacqua MU, Turnbull L, Saunders S, Er L, Chiu H, Hill P, Singh RS, Levin A, Copland MA, Jamal A, Brumby C, Dunne O, Taylor PA. Evaluation of A 12-Month Pilot of Long-Term and Temporary Assisted Peritoneal Dialysis. Perit Dial Int 2017; 37:307-313. [DOI: 10.3747/pdi.2016.00201] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/20/2016] [Indexed: 11/15/2022] Open
Abstract
Background Peritoneal dialysis (PD) is challenging for patients with functional limitations, and assisted PD can support these patients, but previous reports of assisted PD have not examined the role of temporary assisted PD and had difficulty identifying adequate comparator cohorts. Methods Peritoneal Dialysis Assist (PDA), a 12-month pilot of long-term and temporary assisted PD was completed in multiple PD centers in British Columbia, Canada. Continuous cycler PD (CCPD) patients were identified for PDA by standardized criteria, and service could be long-term or temporary/respite. The PDA program provided daily assistance with cycler dismantle and setup, but patients remained responsible for cycler connections and treatment decisions. Outcomes were compared against both the general CCPD population and patients who met PDA criteria but were not enrolled (PDA-eligible). Results Fifty-three PDA patients had an 88% 1-year death- and transplant-censored technique survival that was similar to the general CCPD cohort (84%) and PDA-eligible cohort (86%). The PDA cohort had lower peritonitis rates (0.18 episodes/patient-year vs 0.22 and 0.36, respectively), but higher hospitalization (55% vs 34% and 35%, respectively). Long-term PDA cost approximately CDN$15,000/year in addition to existing dialysis costs. A total of 8/11 respite PDA patients (73%) returned to self-care PD after a median PDA use of 29 days, which costs $1,250/patient. Conclusions Peritoneal Dialysis Assist provides effective support to functionally-limited CCPD patients and yields acceptable clinical outcomes. The program costs less than transfer to HD or long-term care, which represents cost minimization for failing self-care PD patients. Respite PDA provides effective temporary support; most patients returned to self-care PD and service was cost-effective compared with alternatives of hospitalization or transfer to HD.
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Affiliation(s)
- Micheli U. Bevilacqua
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver, BC, Canada; and British Columbia Provincial Renal Agency, Vancouver, BC, Canada
| | - Linda Turnbull
- Vancouver, BC, Canada; and British Columbia Provincial Renal Agency, Vancouver, BC, Canada
| | - Sushila Saunders
- Vancouver, BC, Canada; and British Columbia Provincial Renal Agency, Vancouver, BC, Canada
| | - Lee Er
- Vancouver, BC, Canada; and British Columbia Provincial Renal Agency, Vancouver, BC, Canada
| | - Helen Chiu
- Vancouver, BC, Canada; and British Columbia Provincial Renal Agency, Vancouver, BC, Canada
| | - Penny Hill
- Vancouver, BC, Canada; and British Columbia Provincial Renal Agency, Vancouver, BC, Canada
| | - Rajinder S. Singh
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver, BC, Canada; and British Columbia Provincial Renal Agency, Vancouver, BC, Canada
| | - Michael A. Copland
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Abeed Jamal
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Brumby
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Orla Dunne
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Paul A. Taylor
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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16
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Mudge DW, Boudville N, Brown F, Clayton P, Duddington M, Holt S, Johnson DW, Jose M, Saweirs W, Sud K, Voss D, Walker R. Peritoneal dialysis practice in Australia and New Zealand: A call to sustain the action. Nephrology (Carlton) 2017; 21:535-46. [PMID: 26807739 DOI: 10.1111/nep.12731] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/09/2015] [Accepted: 01/19/2016] [Indexed: 01/08/2023]
Abstract
This paper updates a previous 'Call to Action' paper (Nephrology 2011; 16: 19-29) that reviewed key outcome data for Australian and New Zealand peritoneal dialysis patients and made recommendations to improve care. Since its publication, peritonitis rates have improved significantly, although they have plateaued more recently. Peritoneal dialysis patient and technique survival in Australian and New Zealand have also improved, with a reduction in the proportion of technique failures attributed to 'social reasons'. Despite these improvements, technique survival rates overall remain lower than in many other parts of the world. This update includes additional practical recommendations based on published evidence and emerging initiatives to further improve outcomes.
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Affiliation(s)
- David W Mudge
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Neil Boudville
- School of Medicine and Pharmacology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Fiona Brown
- Monash Medical Centre, Melbourne, Victoria, Australia
| | - Philip Clayton
- Department of Renal Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Stephen Holt
- Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Matthew Jose
- Department of Nephrology, Royal Hobart Hospital & Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Walaa Saweirs
- Renal Unit, Whangarei Hospital, Whangarei, New Zealand
| | - Kamal Sud
- Nepean Clinical School, and Department of Renal Medicine, Nepean Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - David Voss
- Renal Department, Middlemore Hospital, Auckland, New Zealand
| | - Rowan Walker
- Department of Renal Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
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17
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Oliver MJ, Al-Jaishi AA, Dixon SN, Perl J, Jain AK, Lavoie SD, Nash DM, Paterson JM, Lok CE, Quinn RR. Hospitalization Rates for Patients on Assisted Peritoneal Dialysis Compared with In-Center Hemodialysis. Clin J Am Soc Nephrol 2016; 11:1606-1614. [PMID: 27464838 PMCID: PMC5012487 DOI: 10.2215/cjn.10130915] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 05/21/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Assisted peritoneal dialysis is a treatment option for individuals with barriers to self-care who wish to receive home dialysis, but previous research suggests that this treatment modality is associated with a higher rate of hospitalization. The objective of our study was to determine whether assisted peritoneal dialysis has a different rate of hospital days compared to in-center hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a multicenter, retrospective cohort study by linking a quality assurance dataset to administrative health data in Ontario, Canada. Subjects were accrued between January 1, 2004 and July 9, 2013. Individuals were grouped into assisted peritoneal dialysis (family or home care assisted) or in-center hemodialysis on the basis of their first outpatient dialysis modality. Inverse probability of treatment weighting using a propensity score was used to create a sample in which the baseline covariates were well balanced. RESULTS The study included 872 patients in the in-center hemodialysis group and 203 patients in the assisted peritoneal dialysis group. Using an intention to treat approach, patients on assisted peritoneal dialysis had a similar hospitalization rate of 11.1 d/yr (95% confidence interval, 9.4 to 13.0) compared with 12.9 d/yr (95% confidence interval, 10.3 to 16.1) in the hemodialysis group (P=0.19). Patients on assisted peritoneal dialysis were more likely to be hospitalized for dialysis-related reasons (admitted for 2.4 d/yr [95% confidence interval, 1.8 to 3.2] compared with 1.6 d/yr [95% confidence interval, 1.1 to 2.3] in the hemodialysis group; P=0.04). This difference was partly explained by more hospital days because of peritonitis. Modality switching was associated with high rates of hospital days per year. CONCLUSIONS Assisted peritoneal dialysis was associated with similar rates of all-cause hospitalization compared with in-center hemodialysis. Patients on assisted peritoneal dialysis who experienced peritonitis and technique failure had high rates of hospitalization.
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Affiliation(s)
- Matthew J. Oliver
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Nephrology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Ahmed A. Al-Jaishi
- Kidney, Dialysis and Transplantation Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Stephanie N. Dixon
- Kidney, Dialysis and Transplantation Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Jeffrey Perl
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Nephrology, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Arsh K. Jain
- Kidney, Dialysis and Transplantation Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Division of Nephrology, London Health Sciences Center, London, Ontario, Canada
| | - Susan D. Lavoie
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Danielle M. Nash
- Kidney, Dialysis and Transplantation Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Charmaine E. Lok
- Division of Nephrology, University Health Network–Toronto General Hospital, Toronto, Ontario, Canada; and
| | - Robert R. Quinn
- Departments of Medicine and
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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18
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Mehrotra R, Devuyst O, Davies SJ, Johnson DW. The Current State of Peritoneal Dialysis. J Am Soc Nephrol 2016; 27:3238-3252. [PMID: 27339663 DOI: 10.1681/asn.2016010112] [Citation(s) in RCA: 316] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Technical innovations in peritoneal dialysis (PD), now used widely for the long-term treatment of ESRD, have significantly reduced therapy-related complications, allowing patients to be maintained on PD for longer periods. Indeed, the survival rate for patients treated with PD is now equivalent to that with in-center hemodialysis. In parallel, changes in public policy have spurred an unprecedented expansion in the use of PD in many parts of the world. Meanwhile, our improved understanding of the molecular mechanisms involved in solute and water transport across the peritoneum and of the pathobiology of structural and functional changes in the peritoneum with long-term PD has provided new targets for improving efficiency and for intervention. As with hemodialysis, almost half of all deaths on PD occur because of cardiovascular events, and there is great interest in identifying modality-specific factors contributing to these events. Notably, tremendous progress has been made in developing interventions that substantially reduce the risk of PD-related peritonitis. Yet the gains have been unequal among individual centers, primarily because of unequal clinical application of knowledge gained from research. The work to date has further highlighted the areas in need of innovation as we continue to strive to improve the health and outcomes of patients treated with PD.
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Affiliation(s)
- Rajnish Mehrotra
- Kidney Research Institute and .,Harborview Medical Center, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Olivier Devuyst
- Institute of Physiology, University of Zurich, Zurich, Switzerland.,Division of Nephrology, Université Catholique de Louvain Medical School, Brussels, Belgium
| | - Simon J Davies
- Department of Nephrology, Keele University, Staffordshire, United Kingdom; and
| | - David W Johnson
- Department of Nephrology, Division of Medicine, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
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19
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Benabed A, Bechade C, Ficheux M, Verger C, Lobbedez T. Effect of assistance on peritonitis risk in diabetic patients treated by peritoneal dialysis: report from the French Language Peritoneal Dialysis Registry. Nephrol Dial Transplant 2016; 31:656-62. [DOI: 10.1093/ndt/gfw011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/07/2016] [Indexed: 01/06/2023] Open
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20
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Wu X, Yang X, Liu X, Yi C, Guo Q, Feng X, Mao H, Huang F, Yu X. Patient Survival and Technique Failure in Continuous Ambulatory Peritoneal Dialysis Patients with Prior Stroke. Perit Dial Int 2015; 36:308-14. [PMID: 26634563 DOI: 10.3747/pdi.2014.00030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 12/04/2014] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND To investigate patient survival and technical failure of patients with prior stroke receiving continuous ambulatory peritoneal dialysis (CAPD) in Southern China. ♦ METHODS This was a retrospective study. All subjects were recruited from the peritoneal dialysis center in The First Affiliated Hospital of Sun Yat-sen University from 1 January 2006 to 31 December 2010. All eligible patients were assigned to stroke group and non-stroke group according to a history of stroke before receiving CAPD. The primary outcomes were all-cause mortality and death-censored technical failure. Cox regression was used to estimate risk factors of all-cause mortality and death-censored technique failure. ♦ RESULTS Of the 1,068 recruited patients, 75 (7.0%) patients had a previous history of stroke. The all-cause mortality and death-censored technique failure were significantly higher in the stroke group compared with the non-stroke group, respectively (odds ratio [OR] 2.67, 95% confidence interval [CI] 1.59 - 4.46 and OR 2.52, 95% CI 1.19 - 5.34). Older age (changed by 10 years, hazard ratio [HR] 1.90, 95% CI 1.07 - 3.38), lower body mass index (BMI 18.5 - 23.9 vs < 18.5 kg/m(2) reference, HR 0.17, 95% CI 0.05 - 0.55) and time to the first episode of peritonitis (HR 0.93, 95% CI 0.89 - 0.96) were independently associated with increased risk of all-cause mortality in patients with prior stroke. In addition, time to the first episode of peritonitis was associated with decreased risk of death-censored technique failure (HR 0.91, 95% CI 0.84 - 0.99) in those with prior stroke. ♦ CONCLUSIONS Continuous ambulatory peritoneal dialysis patients with prior stroke had high rates of all-cause mortality and technique failure compared with those without prior stroke. Older age, lower BMI, and time to the first episode of peritonitis were independent risk factors of all-cause mortality in patients with prior stroke.
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Affiliation(s)
- Xianfeng Wu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, and Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, and Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Xinhui Liu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, and Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, and Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Qunying Guo
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, and Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Xiaoran Feng
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, and Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, and Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Fengxian Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, and Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, and Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
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Zhang L, Hawley CM, Johnson DW. Focus on peritoneal dialysis training: working to decrease peritonitis rates. Nephrol Dial Transplant 2015; 31:214-22. [PMID: 26908816 DOI: 10.1093/ndt/gfu403] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/02/2014] [Indexed: 11/12/2022] Open
Abstract
Patient training has widely been considered to be one of the most critical factors for achieving optimal peritoneal dialysis clinical outcomes, including avoidance of peritonitis. However, research in this important area has been remarkably scant to date. This article will critically review the clinical evidence underpinning PD patient training and will specifically focus on four key areas: who should provide training and how, when and where should it be performed to obtain the best results. Evidence gaps and future research directions will also be discussed.
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Affiliation(s)
- Lei Zhang
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
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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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Harwood L, Clark AM. Dialysis modality decision-making for older adults with chronic kidney disease. J Clin Nurs 2014; 23:3378-90. [PMID: 24646195 DOI: 10.1111/jocn.12582] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2014] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To examine the personal and structural facilitators and barriers for home-dialysis decision-making for older adults with chronic kidney disease. BACKGROUND Chronic illness is a global problem. Older adults with chronic kidney disease form a large and growing segment of the dialysis population in many high-income countries but are less likely to uptake home-dialysis despite its benefits. DESIGN This qualitative ethnography framed in social theory took place in Canada and included adults with chronic kidney disease not on dialysis, older than 65 years of age. METHODS Thirteen people (seven men and six women, aged 65-83 years of age) who received care in a team chronic kidney disease clinic took part. Persons with chronic kidney disease were interviewed and group interviews were conducted with four of their chronic kidney disease clinic healthcare professionals. Content analysis was used for data analysis. RESULTS The factors influencing older adults' chronic kidney disease modality decisions are similar to younger adults. However, older adults with chronic kidney disease are in a precarious state with persistent uncertainty. Age imposes some limitations on modality options and transplantation. Modality decisions were influenced by health status, gender, knowledge, values, beliefs, past experience, preferences, lifestyle and resources. Support from family and healthcare professionals was the largest determinant to home-dialysis selection. CONCLUSION The social and contextual factors associated with age influenced home-dialysis decision-making. Adequate social support, functional status and resources enabled home-dialysis selection. RELEVANCE TO CLINICAL PRACTICE Understanding more about the decision-making processes for older adults with chronic kidney disease is important for quality interventions and the economic sustainability of dialysis services.
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Affiliation(s)
- Lori Harwood
- London Health Sciences Centre, London, ON, Canada; University of Alberta, Edmonton, AB, Canada; Arthur Labatt and Family School of Nursing, Western University, London, ON, Canada
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