Health Outcomes and Cost Considerations of Assisted Peritoneal Dialysis: A Narrative Review

• Published in: Blood purification Vol. 50; no. 4-5; pp. 662 - 666
• Main Authors: Maierean, Serban M., Oliver, Matthew J.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland 2021
• Subjects: Hospitalization - economics; Humans; Kidney Failure, Chronic - economics; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; Outcome Assessment, Health Care; Peritoneal Dialysis - economics; Peritoneal Dialysis - methods; Peritoneal Dialysis - mortality; Quality of Life; Review - Advances in CKD 2021; Hemodialysis; Mortality; Barriers; Assisted peritoneal dialysis; Cost; Outcomes; Quality of life
• ISSN: 0253-5068; 1421-9735
• DOI: 10.1159/000512839

Background: Peritoneal dialysis (PD) is underutilized in many parts of the world despite pro-PD health policies. The physical and cognitive demands of PD means that over half of eligible patients require some form of assistance. As such, many countries now offer assisted PD (aPD) programs to help patients start or stay on PD as opposed to in-center hemodialysis (HD). In order to evaluate the potential scope of aPD, it is important to review the outcomes and cost considerations of aPD. Summary: We reviewed available data from different countries and regions for health outcomes between aPD and in-center HD, with a focus on quality of life (QoL), mortality, hospitalization, and technique survival. We also evaluated studies discussing the overall costs of delivering aPD, including training, operating costs, and indirect costs and compared these to in-center HD costs for the same regions. Key Messages: aPD patients are older and more frail than either self-care PD patients and many in-center HD patients. We found no evidence for any difference in QoL, mortality, or hospitalization between aPD and in-center HD after adjustment for these differences. There is some evidence for an association between nurse assistance and improved technique survival as compared to family assistance or self-care PD. Despite increased cost of providing assistance in PD, it is still significantly less expensive than in-center HD in Western Europe and Canada.