Discontinuation rate helps track fallout among patients on peritoneal dialysis
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Key takeaways:
- Researchers at Satellite Healthcare use a discontinuation risk assessment to help patients stay engaged on peritoneal dialysis.
- PD discontinuation is common and is associated with poor clinical outcomes.
SAN DIEGO — Researchers at Satellite Healthcare and Stanford University School of Medicine have developed a discontinuation risk assessment process to help keep patients on peritoneal dialysis, according to a presentation here.
“Peritoneal dialysis offers many potential advantages to people with end-stage kidney disease,” Wael F. Hussein, MBBS, MS, chief medical officer of research and development for Satellite Healthcare, and colleagues wrote in a poster presented at the Annual Dialysis Conference. “PD discontinuation is common and is associated with poor clinical outcomes and increased costs to the health care system. Identification of patients at high risk for PD discontinuation might allow for avoidance of PD discontinuation or smoother transitions to hemodialysis when appropriate.”
Hussein and colleagues created the Staying Home program and implemented an assessment process at three home dialysis units in Northern California managed by Satellite Healthcare from March 2022 to May 2022.
“We used the PD surprise question, ‘Would you be surprised if this patient transferred to hemodialysis in the next 6 months?’ to identify high-risk patients,” Hussein and colleagues wrote. “Risk factors were then identified by interdisciplinary team discussions, supported by a risk identification and intervention tool,” they wrote. “Interventions addressing identified risks were then implemented by clinical teams.”
Those risk factors included psychosocial issues, which were most dominant among the patient population, Hussein and colleagues wrote. The group then provided interventions, including staff-assisted PD, dialysis prescription adjustment, home visits by staff and respite care.
With those interventions, the Staying Home program was able to slow the decrease in patients leaving PD, according to the researchers. Patients in a high-risk cohort for discontinuing PD were moved to a lower-risk cohort after the interventions.
According to the poster, factors influencing success of implementing the Staying Home program included team engagement, adequate staffing support, effective communication with the interdisciplinary team and referring physicians, ongoing feedback, celebration of success and support from the leadership team.
“The study demonstrates that a systematic approach to recognizing high-risk PD patients and intervening is feasible, potentially improving patient care and reducing PD discontinuation,” the researchers wrote.
Reference:
Hussein WF, et al. Improving peritoneal dialysis retention through a standardized discontinuation risk. Presented at: Annual Dialysis Conference; March 8-10, 2024. San Diego.
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Hussein WF, et al. Improving peritoneal dialysis retention through a standardized discontinuation risk. Presented at: Annual Dialysis Conference; March 8-10, 2024. San Diego.
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