Abstract
In Europe, the number of elderly end-stage kidney disease patients is increasing. Few of those patients receive peritoneal dialysis (PD), as many cannot perform PD autonomously. Assisted PD programmes are available in most European countries, but the percentage of patients receiving assisted PD varies considerably. Hence, we assessed which factors are associated with the availability of an assisted PD programme at a centre level and whether the availability of this programme is associated with proportion of home dialysis patients. An online survey was sent to healthcare professionals of European nephrology units. After selecting one respondent per centre, the associations were explored by χ2 tests and (ordinal) logistic regression. In total, 609 respondents completed the survey. Subsequently, 288 respondents from individual centres were identified; 58% worked in a centre with an assisted PD programme. Factors associated with availability of an assisted PD programme were Western European and Scandinavian countries (OR: 5.73; 95% CI: 3.07-10.68), non-academic centres (OR: 2.01; 95% CI: 1.09-3.72) and centres with a dedicated team for education (OR: 2.87; 95% CI: 1.35-6.11). Most Eastern & Central European respondents reported that the proportion of incident and prevalent home dialysis patients was <10% (72% and 63%), while 27% of Scandinavian respondents reported a proportion of >30% for both incident and prevalent home dialysis patients. Availability of an assisted PD programme was associated with a higher incidence (cumulative OR: 1.91; 95% CI: 1.21-3.01) and prevalence (cumulative OR: 2.81; 95% CI: 1.76-4.47) of patients on home dialysis. Assisted PD was more commonly offered among non-academic centres with a dedicated team for education across Europe, especially among Western European and Scandinavian countries where higher incidence and prevalence of home dialysis patients was reported.
Highlights
Factors associated with availability of an assisted peritoneal dialysis (PD) programme were Western European and Scandinavian countries (OR: 5.73; 95% CI: 3.07–10.68), non-academic centres (OR: 2.01; 95% CI: 1.09–3.72) and centres with a dedicated team for education (OR: 2.87; 95% CI: 1.35–6.11)
Availability of an assisted PD programme was associated with a higher incidence and prevalence of patients on home dialysis
Since 2001, the number of end-stage kidney disease (ESKD) patients worldwide treated with dialysis has increased from 1 to 2 million and is expected to double again by 2030.1–3 The majority of these patients are treated with in-centre haemodialysis (ICHD),[4,5] treatment with peritoneal dialysis (PD) has many advantages: it can be performed at home, there is no need for a vascular access and patients’ residual kidney function is better preserved.[6,7]
Summary
Since 2001, the number of end-stage kidney disease (ESKD) patients worldwide treated with dialysis has increased from 1 to 2 million and is expected to double again by 2030.1–3 The majority of these patients are treated with in-centre haemodialysis (ICHD),[4,5] treatment with peritoneal dialysis (PD) has many advantages: it can be performed at home, there is no need for a vascular access and patients’ residual kidney function is better preserved.[6,7] These advantages are especially relevant for the increasing number of elderly patients, who form the bulk of ESKD patients.[8,9] the percentage of elderlyESKD patients receiving PD is low and varies between 4% and 21% depending on the country.[4,5,8,10,11]If given a choice, many more elderly would like to receive PD, but comorbidity and frailty often limit the possibility to perform self-care PD.[9,12,13] Important conditions that limit self-care PD include decreased strength to lift PD bags, decreased dexterity, decreased vision, anxiety and cognitive impairment.[12,14] Due to these conditions, up to 80% of elderly patients need some degree of assistance while performing PD.[15,16,17,18]. ESKD patients receiving PD is low and varies between 4% and 21% depending on the country.[4,5,8,10,11]. In Europe, the number of elderly end-stage kidney disease patients is increasing. Few of those patients receive peritoneal dialysis (PD), as many cannot perform PD autonomously. Assisted PD programmes are available in most European countries, but the percentage of patients receiving assisted PD varies considerably. We assessed which factors are associated with the availability of an assisted PD programme at a centre level and whether the availability of this programme is associated with proportion of home dialysis patients
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