A Global Overview of the Impact of Peritoneal Dialysis First or Favored Policies: An Opinion

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Abstract

Given the ever-increasing burden of end-stage renal disease (ESRD) in a global milieu of limited financial and health resources, interested parties continue to search for ways to optimize dialysis access. Government and payer initiatives to increase access to renal replacement therapies (RRTs), particularly peritoneal dialysis (PD) and hemodialysis (HD), may have meaningful impacts from clinical and health-economic perspectives; and despite similar clinical and humanistic outcomes between the two dialysis modalities, PD may be the more convenient and resource-conscious option. This review assessed country-specific PD-First/Favored policies and their associated background, implementation, and outcomes. It was found that barriers to policy-implementation are broadly associated with government policy, economics, provider or healthcare professional education, modality-related factors, and patient-related factors. Notably, the success of a given country's PD-Favored policy was inversely associated with the extent of HD infrastructure. It is hoped that this review will provide a foundation across countries to share lessons learned during the development and implementation of PD-First/Favored policies.

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The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies

R Morton, A Tong, Mary Howard … (2010)

Objective To synthesise the views of patients and carers in decision making regarding treatment for chronic kidney disease, and to determine which factors influence those decisions. Design Systematic review of qualitative studies of decision making and choice for dialysis, transplantation, or palliative care, and thematic synthesis of qualitative studies. Data sources Medline, PsycINFO, CINAHL, Embase, social work abstracts, and digital theses (database inception to week 3 October 2008) to identify literature using qualitative methods (focus groups, interviews, or case studies). Review methods Thematic synthesis involved line by line coding of the findings of the primary studies and development of descriptive and analytical themes. Results 18 studies that reported the experiences of 375 patients and 87 carers were included. 14 studies focused on preferences for dialysis modality, three on transplantation, and one on palliative management. Four major themes were identified as being central to treatment choices: confronting mortality (choosing life or death, being a burden, living in limbo), lack of choice (medical decision, lack of information, constraints on resources), gaining knowledge of options (peer influence, timing of information), and weighing alternatives (maintaining lifestyle, family influences, maintaining the status quo). Conclusions The experiences of other patients greatly influenced the decision making of patients and carers. The problematic timing of information about treatment options and synchronous creation of vascular access seemed to predetermine haemodialysis and inhibit choice of other treatments, including palliative care. A preference to maintain the status quo may explain why patients often remain on their initial therapy.

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Propensity-matched mortality comparison of incident hemodialysis and peritoneal dialysis patients.

David T Gilbertson, Susan J. Snyder, Eric D Weinhandl … (2010)

Contemporary comparisons of mortality in matched hemodialysis and peritoneal dialysis patients are lacking. We aimed to compare survival of incident hemodialysis and peritoneal dialysis patients by intention-to-treat analysis in a matched-pair cohort and in subsets defined by age, cardiovascular disease, and diabetes. We matched 6337 patient pairs from a retrospective cohort of 98,875 adults who initiated dialysis in 2003 in the United States. In the primary intention-to-treat analysis of survival from day 0, cumulative survival was higher for peritoneal dialysis patients than for hemodialysis patients (hazard ratio 0.92; 95% CI 0.86 to 1.00, P = 0.04). Cumulative survival probabilities for peritoneal dialysis versus hemodialysis were 85.8% versus 80.7% (P < 0.01), 71.1% versus 68.0% (P < 0.01), 58.1% versus 56.7% (P = 0.25), and 48.4% versus 47.3% (P = 0.50) at 12, 24, 36, and 48 months, respectively. Peritoneal dialysis was associated with improved survival compared with hemodialysis among subgroups with age <65 years, no cardiovascular disease, and no diabetes. In a sensitivity analysis of survival from 90 days after initiation, we did not detect a difference in survival between modalities overall (hazard ratio 1.05; 95% CI 0.96 to 1.16), but hemodialysis was associated with improved survival among subgroups with cardiovascular disease and diabetes. In conclusion, despite hazard ratio heterogeneity across patient subgroups and nonconstant hazard ratios during the follow-up period, the overall intention-to-treat mortality risk after dialysis initiation was 8% lower for peritoneal dialysis than for matched hemodialysis patients. These data suggest that increased use of peritoneal dialysis may benefit incident ESRD patients.

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Relationship between dialysis modality and mortality.

Kevan Polkinghorne, Michael P. McDonald, Christian Marshall … (2008)

Mortality differences between peritoneal dialysis (PD) and hemodialysis (HD) are widely debated. In this study, mortality was compared between patients treated with PD and HD (including home HD) using data from 27,015 patients in the Australia and New Zealand Dialysis and Transplant Registry, 25,287 of whom were still receiving PD or HD 90 d after entry into the registry. Overall mortality rates were significantly lower during the 90- to 365-d period among those being treated with PD at day 90 (adjusted hazard ratio [HR] 0.89; 95% confidence interval [CI] 0.81 to 0.99]; P < 0.001). This effect, however, varied in direction and size with the presence of comorbidities: Younger patients without comorbidities had a mortality advantage with PD treatment, but other groups did not. After 12 mo, the use of PD at day 90 was associated with significantly increased mortality (adjusted HR 1.33; 95% CI 1.24 to 1.42; P < 0.001). In a supplementary as-treated analysis, PD treatment was associated with lower mortality during the first 90 d (adjusted HR 0.67; 95% CI 0.56 to 0.81; P < 0.001). These data suggest that the effect of dialysis modality on survival for an individual depends on time, age, and presence of comorbidities. Treatment with PD may be advantageous initially but may be associated with higher mortality after 12 mo.

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Author and article information

Journal

Journal ID (nlm-ta): Perit Dial Int

Journal ID (iso-abbrev): Perit Dial Int

Journal ID (hwp): pdi

Title: Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis

Publisher: Multimed Inc

ISSN (Print): 0896-8608

ISSN (Electronic): 1718-4304

Publication date (Print): Jul-Aug 2015

Volume: 35

Issue: 4

Pages: 406-420

Affiliations

[1 ]Baxter Healthcare Corporation, Deerfield, IL, USA

[2 ]Pharmerit International, Bethesda, MD, USA

[3 ]Hollister Incorporated, Libertyville, IL, USA

[4 ]Banphaeo Hospital, Prommitr branch, Bangkok, Thailand

[5 ]Pontificia Universidade Católica do Paraná, School of Medicine, Curitiba, Parana, Brazil

[6 ]Hong Kong Baptist Hospital, Hong Kong, China

Author notes

Correspondence to: Frank Xiaoqing Liu, PhD, Sr. Manager, Global Health Economics and Outcomes Research, Baxter Healthcare Corp., One Baxter Parkway, Deerfield, IL 60015 USA. Xiaoqing_liu@ 123456baxter.com

Article

DOI: 10.3747/pdi.2013.00204

PMC ID: 4520723

PubMed ID: 25082840

SO-VID: 66ab3ba8-5e70-4757-9fff-c7c194d5707e

License:

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. For commercial re-use, please contact marketing@ 123456multi-med.com

History

Date received : 29 July 2013

Date accepted : 25 February 2014

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cover-date July-August 2015

Keywords: peritoneal dialysis,peritoneal dialysis first policy,peritoneal dialysis favored policy,global overview

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Keywords: peritoneal dialysis, peritoneal dialysis first policy, peritoneal dialysis favored policy, global overview

A Global Overview of the Impact of Peritoneal Dialysis First or Favored Policies: An Opinion

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Karger: Nephrology

Most cited references 100

The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies

Propensity-matched mortality comparison of incident hemodialysis and peritoneal dialysis patients.

Relationship between dialysis modality and mortality.

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