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Study explores reasons for low use of PD internationally
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While peritoneal dialysis has its advantages, there are many factors to consider when choosing this form of dialysis for a patient. Internationally, in-center treatment is still the most widely practice of treatment, according to a recently published narrative review.
“This narrative review explores international trends in PD use, with the aim of identifying some of the underlying drivers and suggesting directions that can be adopted to try to rebalance the situation,” the authors wrote. “By providing kidney transplantation or home dialysis to a substantial proportion of their patients, several countries are able to contain the use of in-center HD to less than a third of the ESKD population.”
During the investigation, researchers found many factors contribute to the relatively low world-wide prevalence of PD vs. hemodialysis (HD). The only absolute factor against the use of PD is the absence of a functioning peritoneal membrane, according to the review. Other factors that might reduce the likelihood of PD use include primary diagnosis and physical dexterity, as well as cognitive and visual difficulties.
Several factors outside of the individual patient may also come into play include service availability, cost of the service to a patient or a provider and physician enthusiasm. Additionally, lower use of PD can be attributed to the availability of treatment pathways for patients who present with unplanned advanced CKD.
“There is a strong relationship between patient-targeted education and subsequent selection and use of PD, with a three-fold increase in the odds of receiving PD as the initial treatment modality,” the authors wrote. “In general, patients and family caregivers value treatment that lengthens survival and can occur at home, includes dialysis-free days and permits respite and travel. U.S. patients prioritize independence, quality and quantity of life, and flexibility in daily schedule.”
In certain regions, PD use is emphasized in dependent or elderly patients. According to the Netherlands Cooperative Study on the Adequacy of Dialysis referenced in this review, patients 70 years or older were six times more likely to receive HD rather than PD compared to patients aged 18 to 40 years. More than half of those patients aged 70 years or older were eligible for support and education to receive PD treatment.
“An important explanation for the low prevalence of PD is that mean time on the therapy is only between 2 and 3 years, in part due to high rates of technique failure,” the authors wrote. “In a study from [the Australia and New Zealand Dialysis and Transplant Registry], 18% of PD patients switched to HD in the first year. This inability of patients to remain on their chosen therapy places a considerable burden on the individual and on health care systems.”
Researchers suggest that initiatives such as adjusting reimbursement, encouraging percutaneous PD by medical teams and creating urgent starts PD programs for patients could increase the international prevalence of this treatment method. However, patient and health care professional education about treatment, as well as quality improvement programs to reduce technique failure, are crucial factors as well. – by Scott Buzby
Disclosures: Wilkie reports honoraria from Baxter and Fresenius for lecturing and is editor-in-chief of Peritoneal Dialysis International. Davies reports having received Davies speakers honoria from Baxter and Fresenius and research funding from Baxter. The other co-authors report no relevant financial disclosures.
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