Patient satisfaction, quality of life provide clues to PD retention
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As we continue ambitious efforts to help more people with kidney failure choose home dialysis therapies, new surveys and research are showing that patient satisfaction and quality of life may be critical to our success.
We have seen increased adoption of home dialysis in the past decade, especially peritoneal dialysis. But increasing the number of patients is only part of the challenge. We must ensure home treatments are a positive experience right from the start and be proactive in identifying early signs of dissatisfaction and burnout well before technique failure.
Quality of life
The good news is most patients new to home dialysis are strong promoters of their home treatment experience. In a company survey on patient satisfaction among those who were new to PD, we found 81.5% of the 2,705 respondents were considered promoters of their PD dialysis experience with Fresenius Kidney Care. In the 90 days after the survey, we found patients categorized as detractors were 10% more likely to stop PD and more likely to be hospitalized compared with those who were passive or promoters of their PD dialysis experience.
Fresenius presented data at the National Kidney Foundation Spring Clinical Meetings in which we showed how health-related quality of life (HRQoL) is associated with PD attrition in a large patient cohort (n=12,604).
Patients with lower kidney disease quality of life (KDQoL) subscores had 30% to 50% increased risk of attrition, depending on the subscore. Patients who reported fair or poor (vs. excellent) health had a 60% higher risk of PD attrition, and patients who reported being very or extremely (vs. less) bothered by dyspnea or nausea had greater than a 70% higher risk of long-term PD attrition.
Fresenius has taken steps to improve our onboarding of new home patients with earlier education and awareness of treatment options, expanded transitional care opportunities, rolling out home training applications and improving our connected health capabilities. Prior research also suggested that patients who use connected health and remote treatment monitoring are more likely to stay on the therapy longer.
Monitoring on PD
By improving how we monitor patients on PD, we have been able to implement predictive models that alert nurses and physicians to when patients are most likely to be diagnosed with peritonitis, end up in the hospital or may be likely to transition from PD. Predictive models have become another important tool in our effort to improve retention of all patients on PD. Patient-reported outcomes, like patient satisfaction and HRQoL on home dialysis, may also be predictive of technique failure.
As more people living with kidney failure find success in performing their therapy at home, we need to take every measure possible to ensure this experience is not derailed in the first year. Earlier and more-robust training, improved remote monitoring, and predictive analytics, as well as more frequent review of KDQoL and patient satisfaction, can be effective.
- References:
- Parameswaran V, et al. Abstract #355. Presented at: National Kidney Foundation Spring Clinical Meetings. April 5-10, 2022; Boston.
- Wadhwa N, et al. Abstract #36. Presented at: National Kidney Foundation Spring Clinical Meetings. April 5-10, 2022; Boston.
- For more information:
- Dinesh Chatoth, MD, oversees home therapy initiatives for the medical office of Fresenius Medical Care. He can be reached at dinesh.chatoth@freseniusmedicalcare.com.
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