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System-wide approach successfully expands home peritoneal dialysis
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Implementation of an integrated health care delivery model increased the rate of home-based peritoneal dialysis for patients with advanced kidney disease, according to a recently published study.
“The large-scale expansion of peritoneal dialysis must be accompanied by the simultaneous creation of infrastructure that can support patients and their caregivers to stay on home-based dialysis,” Leonid V. Pravoverov, MD, chief of nephrology at Kaiser Permanente’s East Bay service area, told Healio/Nephrology. “This includes having a network of surgeons capable of placing and troubleshooting dialysis catheters, physician and medical staff who are competent to address needs of patients treated with peritoneal dialysis, home dialysis clinics with room for expansion and the availability of well-trained staff to accommodate new and existing patients. To safeguard patients so that they have the uninterrupted means to start and continue this life-sustaining therapy, reliable availability of dialysis supplies is also necessary.”
To assess the effectiveness of a health care delivery system designed to expand PD, researchers from the Kaiser Permanente Northern California conducted a retrospective cohort study of 13,500 patients who initiated PD or hemodialysis between January 2008 to December 2018 (58.1% were men; mean age, 64.3 years).
The system-level intervention consisted of patient and family education, health care professional and organizational education, operational system-level improvements (eg, expanded use of embedded PD catheters and reorganization of PD services tailored to individual medical centers) and the monitoring of quality improvement through reports and performance reviews.
Researchers found that, from 2008 to 2018, initiation of PD increased from 15.2% to 33.8% after applying the intervention (compared with national trends of 6.1% in 2008 to 9.7% in 2018).
In addition, 80.3% of those who initiated PD were still on PD 1 year after initiation. Age-, sex- and race-standardized rates increased from 69.1% in 2008 to 84.2% in 2017.
“There is a large and growing pool of patients with kidney disease who can benefit from home-based dialysis and engage in self-care, which empowers them and helps to preserve their lifestyle and quality of life,” Pravoverov said. “Our study showed that the major expansion of a regional peritoneal dialysis program is possible and safe. Furthermore, the expansion added to our providers’ expertise to help patients stay on peritoneal dialysis longer and strengthened the infrastructure needed to support patients and their families, to ensure success on peritoneal dialysis.”
Alan Go, MD, of the division of research at Kaiser Permanente Northern California, Oakland, told Healio/Nephrology that, “Future efforts should focus on how to scale our efforts and approach on a national level to expand home-based dialysis and to identify how to better personalize which patients with kidney disease will benefit most from different treatment strategies and options.” – by Melissa J. Webb
Disclosures: Go reports grants from the National Institutes of Diabetes, Digestive and Kidney Diseases and the Kaiser Permanente Northern California Community Benefit Fund.
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