Survey reveals some challenges patients face managing peritoneal dialysis
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Key takeaways:
- Many patients saw peritoneal dialysis as beneficial vs. in-center treatment, but they also cited some drawbacks.
- Some patients said that peritoneal dialysis offered too much flexibility for start times.
LONG BEACH, Calif. — Many patients choose home therapy for the flexibility it offers, but not all patients see that as a benefit, according to survey results presented here.
“We typically think of home therapy as giving patients greater flexibility and thus a better lifestyle,” Caroline M. Hsu, MD, MS, a nephrologist and assistant professor at Tufts University School of Medicine in Boston, told Healio. “However, some patients described feeling restricted instead. This mostly referred to time constraints, having to start [peritoneal dialysis] PD early enough in the evening to reach the required duration of treatment before the start of the next day (getting ready for work, taking the kids to school, etc.),” Hsu said in discussing the survey results presented in a poster at the National Kidney Foundation Spring Clinical Meetings.
“Many patients described constantly doing mental calculations for how to fit PD into their day, and this may be where flexibility becomes a burden,” Hsu said. “In addition, some also felt physically restricted and ‘tied down,’ not being able to join their family watching a movie in the next room, for example.”
Hsu and colleagues conducted the survey to identify what patients who choose PD found satisfying about the therapy and what were the perceived drawbacks.
“Peritoneal dialysis is an important kidney failure treatment; reasons for early discontinuation are poorly understood,” Hsu and colleagues wrote. “This qualitative study explores barriers to and facilitators of PD continuation.”
Researchers interviewed current and former patients on PD and their care partners/ family. The interviews covered various aspects of the PD experience, “with focus on stressors that arose and on what factors may have promoted PD continuation or discontinuation in the setting of such challenges,” the authors wrote.
In total, 17 patient and four care partner interviews took place through November 2023, with a mean participant age of 55 ± 16 years.
In the poster, Hsu and colleagues wrote that participants’ experiences “centered around six themes: PD impact on lifestyle; degree of independence; availability of support; technical aspects of PD; home environment and perceived effectiveness of PD therapy.
“Participants also expressed a range of positive and negative feelings toward PD, from ‘gratitude that I’m able to do [PD]’ to ‘it was a burden.’ Positive experiences and feelings facilitate PD continuation, while negative experiences and feelings are barriers to PD continuation.”
Hsu said the researchers were surprised at the support for the home therapy. “ ... I want to note that, for every person who told us they found PD restrictive, at least one other person told us they found it freeing compared to in-center dialysis,” Hsu told Healio. “I think this reinforces that PD has to be individualized. Some patients will thrive when allowed flexibility in their self-management, and some will benefit from more structure.”
Hsu said staff-assisted PD could help patients stay on the therapy. “I do think there’s a role for assisted PD for the vulnerable times in a patient’s journey,” Hsu said. “The start of PD is certainly a time of adjustment and can be daunting. Later on in one’s course, patient and caregiver burnout can develop, and respite care in the form of assisted PD can be helpful.”
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Hsu CM, e al. Poster 405. Presented at: NKF Spring Clinical Meetings; May 14-18, 2024; Long Beach, Calif.
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