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      Home Visit Program Improves Technique Survival in Peritoneal Dialysis

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          Abstract

          Background: Peritoneal dialysis (PD) is a home therapy, and technique survival is related to the adherence to PD prescription at home. The presence of a home visit program could improve PD outcomes. We evaluated its effects on clinical outcome during 1 year of follow-up. Methods: This was a case-control study. The case group included all 96 patients who performed PD in our center on January 1, 2013, and who attended a home visit program; the control group included all 92 patients who performed PD on January 1, 2008. The home visit program consisted of several additional visits to reinforce patients' confidence in PD management in their own environment. Outcomes were defined as technique failure, peritonitis episode, and hospitalization. Clinical and dialysis features were evaluated for each patient. Results: The case group was significantly older (p = 0.048), with a lower grade of autonomy (p = 0.033), but a better hemoglobin level (p = 0.02) than the control group. During the observational period, we had 11 episodes of technique failure. We found a significant reduction in the rate of technique failure in the case group (p = 0.004). Furthermore, survival analysis showed a significant extension of PD treatment in the patients supported by the home visit program (52 vs. 48.8 weeks, p = 0.018). We did not find any difference between the two groups in terms of peritonitis and hospitalization rate; however, trends toward a reduction of Gram-positive peritonitis rates as well as prevalence and duration of hospitalization related to PD problems were identified in the case group. The retrospective nature of the analysis was a limitation of this study. Conclusion: The home visit program improves the survival of PD patients and could reduce the rate of Gram-positive peritonitis and hospitalization. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=365168.

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          Most cited references15

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          The cost of renal dialysis in a UK setting--a multicentre study.

          The UK National Health Service (NHS) will fund renal services using Payment by Results (PbR), from 2009. Central to the success of PbR will be the creation of tariffs that reflect the true cost of medical services. We have therefore estimated the cost of different dialysis modalities in the Cardiff and Vale NHS Trust and six other hospitals in the UK. We used semi-structured interviews with nephrologists, head nurses and business managers to identify the steps involved in delivering the different dialysis modalities. We assigned costs to these using published figures or suppliers' published price lists. The study used mixed costing methods. Dialysis costs were estimated by a combination of microcosting and a top-down approach. Where we did not have access to detailed accounts, we applied values for Cardiff. The most efficient modalities were automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD), the mean annual costs of which were pound21 655 and pound15 570, respectively. Hospital-based haemodialysis (HD) cost pound35 023 per annum and satellite-unit-based HD cost pound32 669. The cost of home-based HD was pound20 764 per year (based on data from only one unit). The main cost drivers for PD were the costs of solutions and management of anaemia. For HD they were costs of disposables, nursing, the overheads associated with running the unit and management of anaemia. Renal tariffs for PbR need to reflect the true cost of dialysis provision if choices about modalities are not to be influenced by erroneous estimates of cost. Knowledge of the true costs of modalities will also maximize the number of established renal failure patients treated by dialysis within the limited funds available from the NHS.
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            Health care costs of peritoneal dialysis technique failure and dialysis modality switching.

            Although there is a strong economic rationale in favor of peritoneal dialysis (PD) over hemodialysis (HD), the potentially costly effect of PD technique failure is an important consideration in PD program promotion that is unknown.
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              Patient and physician predictors of peritoneal dialysis technique failure: a population based, retrospective cohort study.

              The use of peritoneal dialysis (PD) has been declining over the past decade in Canada, and high technique failure rates have been implicated. Studies have examined clinical risk factors for PD technique failure, but few studies have addressed sociodemographic factors driving technique failure. There are no studies examining the effect of physician factors on technique failure.
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                Author and article information

                Journal
                BPU
                Blood Purif
                10.1159/issn.0253-5068
                Blood Purification
                S. Karger AG
                0253-5068
                1421-9735
                2014
                October 2014
                09 July 2014
                : 37
                : 4
                : 286-290
                Affiliations
                aDepartment of Nephrology, Dialysis, and Kidney Transplant, and bInternational Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, and cDepartment of Statistical Sciences, University of Padova, Padova, Italy; dNephrology Department, Antalya Ataturk State Hospital, Antalya Turkey; Departments of eChemical Engineering and fEconomics, BITS, Pilani, India; gCardiometabolic Center, BNH Hospital, Bangkok, Thailand
                Author notes
                *Dr. Francesca Martino, Department of Nephrology, Dialysis, and Kidney Transplant, San Bortolo Hospital, Viale Rodolfi 37, IT-36100 Vicenza (Italy), E-Mail francesca.martino.k@gmail.com
                Article
                365168 Blood Purif 2014;37:286-290
                10.1159/000365168
                25133487
                cd6ab4da-bd74-4976-a72e-b2194f433f91
                © 2014 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 06 June 2014
                : 06 June 2014
                Page count
                Figures: 1, Tables: 3, Pages: 5
                Categories
                Original Paper

                Cardiovascular Medicine,Nephrology
                Technique survival,Peritoneal dialysis,Home visit
                Cardiovascular Medicine, Nephrology
                Technique survival, Peritoneal dialysis, Home visit

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