Selection Of Peritoneal Dialysis Research Articles

Factors associated with peritoneal dialysis selection in patients who received pre‒dialysis education

Factors associated with peritoneal dialysis selection in patients who received pre‒dialysis education

Payment Reform and Health Disparities: Changes in Dialysis Modality under the New Medicare Dialysis Payment System.

To evaluate the effect of the Medicare dialysis payment reform on potential disparities in the selection of peritoneal dialysis (PD) for the treatment of end-stage renal disease (ESRD). Centers for Medicare & Medicaid Services (CMS) ESRD Medical Evidence Form, Medicare claims, and other CMS data for 2008-2013. We examined the association of patient age, race/ethnicity, urban/rural location, pre-ESRD care, comorbidities, insurance, and other factors with the selection of PD as initial dialysis modality across prereform (2008-2009), interim (2010), and postreform (2011-2013) time periods. Selection of PD increased among diverse patient subgroups following the payment reform. However, the lower PD selection observed with older age, black race, Hispanic ethnicity, less pre-ESRD care, and Medicaid insurance before the reform largely remained in the initial postreform years. Despite recent growth in PD, there may be ongoing disparities in access to PD that have largely not been mitigated by the payment reform. There is potential for modifying provider financial incentives to achieve policy goals related to cost and quality of care. However, even with a substantial shift in financial incentives, separate initiatives to reduce existing disparities in care may be needed.

Selection of peritoneal dialysis among older eligible patients with end-stage renal disease.

Older patients with end-stage renal disease (ESRD) are less likely to choose peritoneal dialysis (PD) over hemodialysis (HD). The reasons behind their choice of dialysis modality are not clear. This study seeks to determine the patient-perceived factors that influence ESRD patients' choice of dialysis modality among older ESRD patients who are deemed eligible for both PD and HD. All patients had completed a multidisciplinary modality assessment, were deemed eligible for both PD and HD, and had received modality education. Semi-structured interviews were conducted and transcripts were read repeatedly to derive potential codes using line-by-line textual analysis. The Capability, Opportunity, Motivation – Behaviour (COM-B) and Theoretical Domain Framework (TDF), validated tools that were developed for designing behavioral change interventions, were used to help guide the coding framework. Among older ESRD patients who are deemed eligible for both PD and HD, factors relevant to their modality decision-making were identified with respect to physical strength/dexterity and having a sound mind (capability), external forces and constraints (opportunity), and values and beliefs (motivation). Often a combination of factors led to an individual's choice of a particular dialysis modality. However, preferences for PD were primarily based around convenience and maintaining a normal life, while a heightened sense of security was the primary reason for those who selected HD. We have identified patient-perceived factors that influence choice of dialysis modality in older individuals with ESRD who are eligible for PD and HD. These factors should be considered and/or addressed within PD programs seeking to promote PD.

Ability of vitamin D receptor activator to prevent pulmonary congestion in advanced chronic kidney disease.

Vitamin D deficiency is common among patients with chronic kidney disease (CKD). However, the benefits of vitamin D supplementation versus vitamin D receptor activator (VDRA) administration have yet to be established. Recently, an association between activated vitamin D and cardiovascular factors was reported. To evaluate the benefits of VDRA in advanced CKD, we analyzed the association between VDRA administration and the prevalence of pulmonary congestion. This retrospective, cross-sectional analysis included patients initiated on dialysis between October 2011 and September 2013 at 17 Japanese institutions. Data from 952 participants were analyzed using a multivariate logistic regression model and a linear regression model. We also analyzed subgroup data for groups classified by selection of peritoneal dialysis or hemodialysis. Of the 952 participants, 303 patients received VDRA. VDRA administration was associated with a low prevalence of pulmonary congestion in the multivariate logistic regression model (odds ratio [OR], 0.64; 95 % confidence interval [CI], 0.44-0.94; P = 0.02). There was no significant association between VDRA administration and systolic blood pressure, diastolic blood pressure, or pulse pressure. Subgroup analysis revealed a tendency that VDRA administration was associated with low prevalence of pulmonary congestion in both groups. In this study, VDRA administration was associated with a low prevalence of pulmonary congestion in patients initiated on dialysis. Appropriate VDRA administration may prevent pulmonary congestion.

Theory and Reality in the Selection of Peritoneal Dialysis

Theory and Reality in the Selection of Peritoneal Dialysis

Variability in Case Mix and Peritoneal Dialysis Selection in Fifty-Nine French Districts

In France, the use of peritoneal dialysis (PD) as the first-choice treatment varies greatly between districts, as it is already known to do between countries. Baseline clinical factors associated with choice of first modality were analyzed in 10 815 new end-stage renal disease patients in 59 districts. To describe practices at the district level, we used an agglomerative hierarchical classification, with proximity defined by a likelihood-ratio test that compared multivariate logistic regressions of the following factors: age, gender, diabetes, congestive heart failure, severe behavioral disorders, mobility, and employment. To propose a typology, each cluster of districts was described by a multivariate logistic regression. While populations starting PD in France, as elsewhere, are more likely to be young or employed, they are also more likely to be elderly or have congestive heart failure or severe behavioral disorders. Overall, 14% of patients start with PD, but this rate varies significantly across districts, from 0% to 45%. A specific combination of factors was associated with the first-choice modality in each group of districts. This study highlights the lack of consensual medical criteria for this choice and the likelihood that nonmedical factors may explain the observed differences. The high variability suggests that PD can be used in almost all clinical conditions. Accordingly, patient preference should play a more important role in the decision-making process.

Determinants of Modality Selection among Incident US Dialysis Patients

Few studies have comprehensively addressed the association of social factors and elements of pre-end-stage renal disease (ESRD) care with the selection of dialysis modality. This study examines the relative contribution of demographic, medical, social, pre-ESRD, and geographic factors to modality assignment among new ESRD patients. Data were collected from the Dialysis Mortality and Morbidity Wave 2 Study, a national random sample of 4025 patients in 1996 and 1997. In multivariate analyses, the selection of peritoneal dialysis (PD) over hemodialysis (HD) was significantly associated with younger age, white race, fewer comorbid conditions, and lower serum albumin. Greater use of PD was seen in patients who were employed, married, and living with someone before the start of ESRD and in those who were more autonomous and more accomplished educationally. Patients referred earlier to a nephrologist (> 4 mo versus < or =4 mo) and seen more frequently by a nephrologist (> or =2 visits versus < 2 visits) in the pre-ESRD period had greater PD use. Of the factors listed, 25% of the variability (R(2)) in PD use was explained by demographic (4.1%), comorbid (1.2%), social/pre-ESRD (14.5%), and geographic (5.2%) factors. This study identifies several clinical, social, and pre-ESRD factors with the selection of PD, and it underscores the importance of patient education, autonomy, and a strong social support system in improving rates of PD use in the United States. As pre-ESRD patient care is an important contributor to PD use in the United States, greater efforts should be expended in improving its delivery earlier in the pre-ESRD period.

Early referral and selection of peritoneal dialysis as a treatment modality.

Early referral and selection of peritoneal dialysis as a treatment modality.

The Importance of Pre-Esrd Education and Early Nephrological Care in Peritoneal Dialysis Selection and Outcome

The Importance of Pre-Esrd Education and Early Nephrological Care in Peritoneal Dialysis Selection and Outcome