Cost-Containment in CAPD Patients with Ultrafiltration Failure

Abstract

Continuous ambulatory peritoneal dialysis (CAPD) using glucose-based solutions is used increasingly to treat patients with renal failure. Ultrafiltration failure occurs in CAPD patients after a variable time; the number of CAPD patients with ultrafiltration failure is therefore rising; this presents a situation which could overwhelm the present United Kingdom haemodialysis resources. Icodextrin 7.5% is a new glucose-polymer-based CAPD solution best suited to the long dwell times that present the greatest challenge to patients with ultra-filtration failure. The icodextrin compassionate-use programme was set up to allow CAPD patients access to icodextrin before commercial availability. There was no rigid protocol; patients with ultrafiltration failure received icodextrin (1.5 or 2L) for the long dwell for as long as it was beneficial. The outcome of the programme was analysed by life-table analysis for (a) overall technique survival in all ultrafiltration failure patients in the programme, and (b) CAPD extension time in patients who either stayed in the programme or left it because of worsening ultrafiltration failure. 56 ultrafiltration failure patients were included in the programme. In this group, life-table analysis showed a technique survival of 38% after 1 year. Withdrawals were: 6 transplants, 6 deaths and 23 transfers to haemodialysis. For CAPD extension time due to icodextrin, 36 patients were included: life-table analysis showed that 60% remained on CAPD 12 months after starting icodextrin treatment. Overall, in patients with ultrafiltration failure, the inclusion of icodextrin in the dialysis prescription extended CAPD lifetime by an average of at least 1 year. At current United Kingdom costs, CAPD with the inclusion of icodextrin represents a cost saving of approximately £1500 per annum over hospital-based haemodialysis, as well as the benefit to the patient of remaining on the chosen modality of treatment.