Global, local insights offer ways to improve peritoneal dialysis
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The Peritoneal Dialysis Outcomes and Practice Patterns Study is the largest international prospective cohort study of peritoneal dialysis and related outcomes, providing findings to help inform improvements in peritoneal dialysis care.
The primary objective of the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) is to identify modifiable PD practices associated with improved outcomes. The primary study outcomes are transition to hemodialysis and mortality, with secondary study outcomes including cause-specific transition to hemodialysis, hospitalization and patient-reported outcomes.
Since 2014, PDOPPS has collected detailed data from 20,211 patients on PD at 427 randomly selected PD programs in Australia, Canada, New Zealand, South Korea, Thailand, the United Kingdom and the United States that create a representative sample of national practices.
The PDOPPS is coordinated by Arbor Research Collaborative for Health, in partnership with the International Society for Peritoneal Dialysis (ISPD), and local study country investigators. Representation from each group has been aligned to form the international steering committee of the study plus input from a PDOPPS U.S. Scientific Advisory Group, patients and U.S. dialysis organizations.
Outcomes
Large within- and across-country variability has been seen in facility PD-related outcomes and practices, including use of the PD solution icodextrin, prophylactic antibiotic prescriptions, types of exit site antimicrobial agents used, and frequency and length of PD training. Substantial variation has been seen in PD outcomes as well, such as how long patients remain on PD therapy, peritonitis rates and peritonitis-related outcomes and all-cause mortality.
Complementing the international PD-related research in PDOPPS, the DOPPS Practice Monitor (DPM, www.dopps.org/dpm) which has provided up-to-date results on U.S. hemodialysis practice since 2010, recently expanded to include the most up-to-date longitudinal trends in care of U.S. patients on maintenance PD. The DPM-PD includes anonymized data from nearly 4,000 U.S. patients on PD each month (currently about 7% of the U.S. population on PD).
The DPM-PD facility sample includes approximately 150 dialysis facilities, selected by stratified random sampling from two large U.S. dialysis organizations, and from small and medium-chain facilities. Data are updated every 6 months, with only a 2-month lag between data collection and web posting.
Peritonitis
Another important offshoot of PDOPPS has been the ancillary study, “Optimizing the prevention of PD-associated peritonitis in the U.S.” or OPPUS.
OPPUS has been ongoing since 2018 through a 5-year grant provided by the Agency for Healthcare Research and Quality. PD-associated peritonitis is the leading cause of serious infections in patients on PD, results in increased mortality and morbidity, and is more common than the rates of catheter-related vascular access infections reported in patients on hemodialysis.
Several original articles have already been published from OPPUS, describing large differences in peritonitis rates between countries and across facilities within countries, key patient- and facility-level predictors of PD-associated peritonitis and peritonitis-related outcomes.
Furthermore, an OPPUS Peritonitis Tracker Pilot Study was initiated in 2020 which has been informative for assessing the feasibility of uniform reporting of all peritonitis episodes uring a 1-year period by approximately 60 diverse U.S. PD facilities. Episode reporting is based on peritonitis-related data elements required to meet the ISPD guidelines for defining peritonitis.
A major objective of PDOPPS is that findings from the study and its associated studies (DPM-PD and OPPUS) can be useful for PD team members and patients in informing improvements in PD practices and use. PDOPPS encourages the use of study data by external investigators for specific research projects or to be considered for use by investigators when submitting for funding support for ancillary PD-related studies.
- References:
- Davies SJ, et al. Kidney Int Rep.2021;doi:10.1016/j.ekir.2020.11.021.
- Nataatmadja M, et al. Nephrol Dial Transplant (in press).
- Perl J, et al. Am J Kidney Dis.2020;doi:10.1053/j.ajkd.2019.09.016.
- Perl J, et al. Clin J Am Soc Nephrol. 2021;doi.org/10.2215/CJN.11280919.
- Sahlawi MA, et al. Peri Dial Intl.2020;doi:10.1177/0896860819893810.
- Sahlawi M, et al. Am J Kidney Dis. 2021;doi:10.1053/j.ajkd.2021.03.022.
- For more information:
- Ronald L. Pisoni, PhD, MS, Roberto Pecoits- Filho, MD, PhD, Brian Bieber, MPH, Lauren Kane, MPH, and Bruce M. Robinson, MD, MS, are with Arbor Research Collaborative for Health, Ann Arbor, Michigan. Jeffrey Perl, MD, MS, is with the division of nephrology and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario.
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