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Evaluating Factors Contributing to Dropout in a Large Peritoneal Dialysis Program

      Abstract

      Background

      The low prevalence of peritoneal dialysis (PD) (9%) vs. hemodialysis (HD) (88.2%) is partly due to patient dropout from therapy.

      Methods

      This retrospective study identified patients who withdrew from PD between 2016 and 2018 in our program. We evaluated all other factors as controllable losses. Analysis included time on therapy at dropout (very early, early or late) and method of initiation (HD to PD conversion, unplanned PD, or planned start).

      Results

      Eighty-three patients enrolled into our PD program. 27 dropped out; 24 were due to controllable factors, 3 due to death, with a median age at dropout of 52 years old. We determined psychosocial factors (PF) to be the largest controllable factor influencing dropout; contributing a 63% rate among all controllable factors. When considering time until dropout, 100% of very early dropout patients and 50% of late dropout patients did so due to PF. Among early dropout patients 67% dropped out due to other medical reasons. The mean time to dropout for PF, other, and infection (INF) were 13, 26, and 33 months, respectively. When considering type of initiation, we found PF to be the largest attributable factor with 50% of unplanned, 100% of planned, and 50% of conversions stopping therapy.

      Conclusions

      Our study indicates that the primary reason for controllable loss from therapy was secondary to PF regardless of the time on therapy or the method of initiation to therapy.

      Keywords

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      References

        • United States Renal Data System
        USRDS Annual Data Report.
        United States Renal Data System, 2015
      1. Kidney disease statistics for the united states. The National Institute of Diabetes and Digestive and Kidney Diseases Health Information Center Web site. Available at:https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease. Updated 2016. Accessed July 9, 2020.

        • Goto N.A.
        • van Loon I.N.
        • Boereboom F.T.J.
        • et al.
        Association of initiation of maintenance dialysis with functional status and caregiver burden.
        Clin J Am Soc Nephrol. 2019; 14 ([doi]): 1039-1047https://doi.org/10.2215/CJN.13131118
        • Pulliam J.
        • Li N.C.
        • Maddux F.
        • Hakim R.
        • Finkelstein F.O.
        • Lacson E
        First-year outcomes of incident peritoneal dialysis patients in the United States.
        Am J Kidney Dis. 2014; 64: 761-769https://doi.org/10.1053/j.ajkd.2014.04.025
        • Chaudhary K
        Peritoneal dialysis drop-out: causes and prevention strategies.
        Int J Nephrol. 2011; 2011434608https://doi.org/10.4061/2011/434608
        • Chaudhary K.
        • Sangha H.
        • Khanna R
        Peritoneal dialysis first: rationale.
        Clin J Am Soc Nephrol. 2011; 6: 447-456https://doi.org/10.2215/CJN.07920910
        • Jaar B.G.
        • Plantinga L.C.
        • Crews D.C.
        • et al.
        Timing, causes, predictors and prognosis of switching from peritoneal dialysis to hemodialysis: a prospective study.
        BMC Nephrol. 2009; 10: 3https://doi.org/10.1186/1471-2369-10-3
        • Workeneh B.
        • Guffey D.
        • Minard C.G.
        • Mitch W.E
        Causes for withdrawal in an urban peritoneal dialysis program2015.
        Int J Nephrol. 2015; 2015652953https://doi.org/10.1155/2015/652953
        • Hsu C.K.
        • Lee C.C.
        • Chen Y.T.
        • et al.
        Multidisciplinary predialysis education reduces incidence of peritonitis and subsequent death in peritoneal dialysis patients: 5-year cohort study.
        PLoS One. 2018; 13e0202781https://doi.org/10.1371/journal.pone.0202781
        • Blowey D.L.
        • Warady B.A.
        • McFarland K.S
        The treatment of staphylococcus aureus nasal carriage in pediatric peritoneal dialysis patients.
        Adv Perit Dial. 1994; 10: 297-299
        • Zimmerman S.W.
        • Ahrens E.
        • Johnson C.A.
        • et al.
        Randomized controlled trial of prophylactic rifampin for peritoneal dialysis-related infections.
        Am J Kidney Dis. 1991; 18 (S027263869100152X [pii]): 225-231
        • Luo Q.
        • Xia X.
        • Lin Z.
        • et al.
        Very early withdrawal from treatment in patients starting peritoneal dialysis.
        Ren Fail. 2018; 40: 8-14https://doi.org/10.1080/0886022X.2017.1419965
        • Descoeudres B.
        • Koller M.T.
        • Garzoni D.
        • et al.
        Contribution of early failure to outcome on peritoneal dialysis.
        Perit Dial Int. 2008; 28 (doi: 28/3/259 [pii]): 259-267
        • Bechade C.
        • Guittet L.
        • Evans D.
        • Verger C.
        • Ryckelynck J.P.
        • Lobbedez T
        Early failure in patients starting peritoneal dialysis: a competing risks approach.
        Nephrol Dial Transplant. 2014; 29: 2127-2135https://doi.org/10.1093/ndt/gft055
        • Griva K.
        • Lai A.Y.
        • Lim H.A.
        • Yu Z.
        • Foo M.W.
        • Newman S.P
        Non-adherence in patients on peritoneal dialysis: a systematic review.
        PLoS One. 2014; 9: e89001https://doi.org/10.1371/journal.pone.0089001
        • Wang T.J.
        • Lin M.Y.
        • Liang S.Y.
        • Wu S.F.
        • Tung H.H.
        • Tsay S.L
        Factors influencing peritoneal dialysis patients' psychosocial adjustment.
        J Clin Nurs. 2014; 23: 82-90https://doi.org/10.1111/jocn.12045
        • Ivarsen P.
        • Povlsen J.V
        Can peritoneal dialysis be applied for unplanned initiation of chronic dialysis?.
        Nephrol Dial Transplant. 2014; 29: 2201-2206https://doi.org/10.1093/ndt/gft487
        • Lobbedez T.
        • Lecouf A.
        • Ficheux M.
        • Henri P.
        • Hurault de Ligny B.
        • Ryckelynck J.P
        Is rapid initiation of peritoneal dialysis feasible in unplanned dialysis patients? A single-centre experience.
        Nephrol Dial Transplant. 2008; 23: 3290-3294https://doi.org/10.1093/ndt/gfn213
        • Koch M.
        • Kohnle M.
        • Trapp R.
        • Haastert B.
        • Rump L.C.
        • Aker S
        Comparable outcome of acute unplanned peritoneal dialysis and haemodialysis.
        Nephrol Dial Transplant. 2012; 27: 375-380https://doi.org/10.1093/ndt/gfr262
        • Povlsen J.V.
        • Ivarsen P
        How to start the late referred ESRD patient urgently on chronic APD.
        Nephrol Dial Transplant. 2006; 21 (doi: 21/suppl_2/ii56 [pii]): 9
        • Liu Y.
        • Zhang L.
        • Lin A.
        • Ni Z.
        • Qian J.
        • Fang W
        Impact of break-in period on the short-term outcomes of patients started on peritoneal dialysis.
        Perit Dial Int. 2014; 34: 49-56https://doi.org/10.3747/pdi.2012.00293
        • Porter E.
        • Watson D.
        • Bargman J.M
        Education for patients with progressive CKD and acute-start dialysis.
        Adv Chronic Kidney Dis. 2013; 20: 302-310https://doi.org/10.1053/j.ackd.2013.04.002
        • Rioux J.P.
        • Cheema H.
        • Bargman J.M.
        • Watson D.
        • Chan C.T
        Effect of an in-hospital chronic kidney disease education program among patients with unplanned urgent-start dialysis.
        Clin J Am Soc Nephrol. 2011; 6: 799-804https://doi.org/10.2215/CJN.07090810
        • Hanko J.
        • Jastrzebski J.
        • Nieva C.
        • White L.
        • Li G.
        • Zalunardo N
        Dedication of a nurse to educating suboptimal haemodialysis starts improved transition to independent modalities of renal replacement therapy.
        Nephrol Dial Transplant. 2011; 26: 2302-2308https://doi.org/10.1093/ndt/gfq669
        • Erim G.
        • Mustafa K.
        Reasons for drop-out of peritoneal dialysis and strategies of prevention: a review.
        Eur J Med Sci. 2014; 1: 1-7
        • Schachter M.E.
        • Tennankore K.K.
        • Chan C.T
        Determinants of training and technique failure in home hemodialysis.
        Hemodial Int. 2013; 17: 421-426
        • Chan C.T.
        • Wallace E.
        • Golper T.A.
        • et al.
        Exploring barriers and potential solutions in home dialysis: an NKF-KDOQI conference outcomes report.
        Am J Kidney Dis. 2019; 73 (doi: S0272-6386(18)31060-6 [pii]): 363-371
        • Traisathit P.
        • Moolkham K.
        • Maneeton N.
        • Thongsak N.
        • Maneeton B
        Associated factors for depressive disorder in patients with end-stage renal disease treated with continuous ambulatory peritoneal dialysis.
        Ther Clin Risk Manag. 2019; 15: 541-548https://doi.org/10.2147/TCRM.S186394
        • Zalai D.
        • Szeifert L.
        • Novak M
        Psychological distress and depression in patients with chronic kidney disease.
        Semin Dial. 2012; 25: 428-438https://doi.org/10.1111/j.1525-139X.2012.01100.x
        • Tong A.
        • Sainsbury P.
        • Chadban S.
        • et al.
        Patients' experiences and perspectives of living with CKD.
        Am J Kidney Dis. 2009; 53: 689-700https://doi.org/10.1053/j.ajkd.2008.10.050
        • De Sousa A
        Psychiatric issues in renal failure and dialysis.
        Indian J Nephrol. 2008; 18: 47-50https://doi.org/10.4103/0971-4065.42337
      2. McGill R.L., Weiner D.E., Ruthazer R., Miskulin D.C., Meyer K.B., Lacson E., Jr. Transfers to hemodialysis among US patients initiating renal replacement therapy with peritoneal dialysis. Am J Kidney Dis. doi: 10.1053/j.ajkd.2019.05.014

        • Povlsen J.V
        Unplanned start on assisted peritoneal dialysis.
        Contrib Nephrol. 2009; 163: 261-263https://doi.org/10.1159/000223808
        • Pierratos A.
        • Tremblay M.
        • Kandasamy G.
        • et al.
        Personal support worker (PSW)-supported home hemodialysis: a paradigm shift.
        Hemodial Int. 2017; 21: 173-179
        • Oliver M.J.
        • Garg A.X.
        • Blake P.G.
        • et al.
        Impact of contraindications, barriers to self-care and support on incident peritoneal dialysis utilization.
        Nephrol Dial Transplant. 2010; 25: 2737-2744https://doi.org/10.1093/ndt/gfq085
        • Untas A.
        • Thumma J.
        • Rascle N.
        • et al.
        The associations of social support and other psychosocial factors with mortality and quality of life in the dialysis outcomes and practice patterns study.
        Clin J Am Soc Nephrol. 2011; 6: 142-152https://doi.org/10.2215/CJN.02340310
        • Thong M.S.
        • Kaptein A.A.
        • Krediet R.T.
        • Boeschoten E.W.
        • Dekker F.W
        Social support predicts survival in dialysis patients.
        Nephrol Dial Transplant. 2007; 22 (doi: gfl700 [pii]): 845-850
        • Belasco A.
        • Barbosa D.
        • Bettencourt A.R.
        • Diccini S.
        • Sesso R
        Quality of life of family caregivers of elderly patients on hemodialysis and peritoneal dialysis.
        Am J Kidney Dis. 2006; 48 (doi: S0272-6386(06)01358-8 [pii]): 955-963