Program shows advantages of continuous ambulatory PD vs. automated PD
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Key takeaways:
- Continuous ambulatory PD has advantages over automated PD, including a possible lower risk of peritonitis.
- The number of exchanges can be managed effectively to reduce patient burden.
AUSTIN, Texas —Despite more frequent exchanges, continuous ambulatory peritoneal dialysis may have advantages over automated peritoneal dialysis, including a lower rate of peritonitis, according to study results presented here.
“[Continuous ambulatory PD] may offer advantages to many on peritoneal dialysis,” Michael Kraus, MD, and colleagues wrote in a poster presented at the National Kidney Foundation Spring Clinical Meetings. “An ongoing education program and follow-up of key performance indicators can shift the ‘[automated PD] for all culture’ and grow [continuous ambulatory PD] acceptance,” the authors wrote.
Use of continuous ambulatory PD has declined in recent years and was replaced by automated PD, which patients perform overnight. “[U.S. Renal Data System] data from 2009 to 2020 show a decline in [continuous ambulatory PD] utilization to 13% of [peritoneal dialysis] patients,” Kraus and colleagues wrote. “The continued growth in ‘[automated peritoneal dialysis] for all’ culture is based on perceived biases of educators, physicians and nurses.
“Other industrialized countries utilize [continuous ambulatory PD] commonly,” the authors wrote. “[Automated PD] is associated with more storage, costs and technologies. It may be associated with more burdens with alarms, sleep disruptions and reduced volume control.”
A pilot program at Fresenius Medical Care was developed to re-educate providers on peritoneal dialysis physiology, benefits of continuous ambulatory PD and potential ways of reducing the burden. “The hypothesis is that an education program, monitoring and follow-up of key performance indicators, and ongoing support will allow for growth of [continuous ambulatory PD],” the authors wrote.
According to the poster, the program started with four home dialysis centers with an established base of patients on peritoneal dialysis. The market or unit chosen was a large PD program with a low continuous ambulatory PD utilization of 7.2%. Roll out of the program included education for physicians, advanced practice providers, home nursing staff, social workers and dietitians.
“The education was initiated in late June 2022 with initiation of a pilot study on July 1, 2022. Data collection included a 6-month look back and results of the initial 3 months are promising,” Kraus and colleagues wrote. The number of patients changing to automated PD from continuous ambulatory PD decreased from 17 of 28 patients, or 60.7% (January to June of the pilot program), to five of 26 patients, or 19.2% (July to October of the pilot program).
“There have been no [continuous ambulatory PD] peritonitis cases in the last 3 months, and subjective patient engagement is high,” the authors wrote.
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Kraus M, et al. Poster #364. Presented at: National Kidney Foundation Spring Clinical Meetings; April 11-15, 2023; Austin, Texas.
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