Peritoneal Dialysis Use and Practice Patterns: An International Survey Study
Approximately 11% of people with kidney failure worldwide are treated with peritoneal dialysis (PD). This study examined PD use and practice patterns across the globe. A cross-sectional survey. Stakeholders including clinicians, policy makers, and patient representatives in 182 countries convened by...
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| Published in | American journal of kidney diseases Vol. 77; no. 3; pp. 315 - 325 |
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| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
01.03.2021
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| Abstract | Approximately 11% of people with kidney failure worldwide are treated with peritoneal dialysis (PD). This study examined PD use and practice patterns across the globe.
A cross-sectional survey.
Stakeholders including clinicians, policy makers, and patient representatives in 182 countries convened by the International Society of Nephrology between July and September 2018.
PD use, availability, accessibility, affordability, delivery, and reporting of quality outcome measures.
Descriptive statistics.
Responses were received from 88% (n=160) of countries and there were 313 participants (257 nephrologists [82%], 22 non-nephrologist physicians [7%], 6 other health professionals [2%], 17 administrators/policy makers/civil servants [5%], and 11 others [4%]). 85% (n=156) of countries responded to questions about PD. Median PD use was 38.1 per million population. PD was not available in 30 of the 156 (19%) countries responding to PD-related questions, particularly in countries in Africa (20/41) and low-income countries (15/22). In 69% of countries, PD was the initial dialysis modality for≤10% of patients with newly diagnosed kidney failure. Patients receiving PD were expected to pay 1% to 25% of treatment costs, and higher (>75%) copayments (out-of-pocket expenses incurred by patients) were more common in South Asia and low-income countries. Average exchange volumes were adequate (defined as 3-4 exchanges per day or the equivalent for automated PD) in 72% of countries. PD quality outcome monitoring and reporting were variable. Most countries did not measure patient-reported PD outcomes.
Low responses from policy makers; limited ability to provide more in-depth explanations underpinning outcomes from each country due to lack of granular data; lack of objective data.
Large inter- and intraregional disparities exist in PD availability, accessibility, affordability, delivery, and reporting of quality outcome measures around the world, with the greatest gaps observed in Africa and South Asia. |
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| AbstractList | Approximately 11% of people with kidney failure worldwide are treated with peritoneal dialysis (PD). This study examined PD use and practice patterns across the globe.
A cross-sectional survey.
Stakeholders including clinicians, policy makers, and patient representatives in 182 countries convened by the International Society of Nephrology between July and September 2018.
PD use, availability, accessibility, affordability, delivery, and reporting of quality outcome measures.
Descriptive statistics.
Responses were received from 88% (n=160) of countries and there were 313 participants (257 nephrologists [82%], 22 non-nephrologist physicians [7%], 6 other health professionals [2%], 17 administrators/policy makers/civil servants [5%], and 11 others [4%]). 85% (n=156) of countries responded to questions about PD. Median PD use was 38.1 per million population. PD was not available in 30 of the 156 (19%) countries responding to PD-related questions, particularly in countries in Africa (20/41) and low-income countries (15/22). In 69% of countries, PD was the initial dialysis modality for≤10% of patients with newly diagnosed kidney failure. Patients receiving PD were expected to pay 1% to 25% of treatment costs, and higher (>75%) copayments (out-of-pocket expenses incurred by patients) were more common in South Asia and low-income countries. Average exchange volumes were adequate (defined as 3-4 exchanges per day or the equivalent for automated PD) in 72% of countries. PD quality outcome monitoring and reporting were variable. Most countries did not measure patient-reported PD outcomes.
Low responses from policy makers; limited ability to provide more in-depth explanations underpinning outcomes from each country due to lack of granular data; lack of objective data.
Large inter- and intraregional disparities exist in PD availability, accessibility, affordability, delivery, and reporting of quality outcome measures around the world, with the greatest gaps observed in Africa and South Asia. Approximately 11% of people with kidney failure worldwide are treated with peritoneal dialysis (PD). This study examined PD use and practice patterns across the globe.RATIONALE & OBJECTIVEApproximately 11% of people with kidney failure worldwide are treated with peritoneal dialysis (PD). This study examined PD use and practice patterns across the globe.A cross-sectional survey.STUDY DESIGNA cross-sectional survey.Stakeholders including clinicians, policy makers, and patient representatives in 182 countries convened by the International Society of Nephrology between July and September 2018.SETTING & PARTICIPANTSStakeholders including clinicians, policy makers, and patient representatives in 182 countries convened by the International Society of Nephrology between July and September 2018.PD use, availability, accessibility, affordability, delivery, and reporting of quality outcome measures.OUTCOMESPD use, availability, accessibility, affordability, delivery, and reporting of quality outcome measures.Descriptive statistics.ANALYTICAL APPROACHDescriptive statistics.Responses were received from 88% (n=160) of countries and there were 313 participants (257 nephrologists [82%], 22 non-nephrologist physicians [7%], 6 other health professionals [2%], 17 administrators/policy makers/civil servants [5%], and 11 others [4%]). 85% (n=156) of countries responded to questions about PD. Median PD use was 38.1 per million population. PD was not available in 30 of the 156 (19%) countries responding to PD-related questions, particularly in countries in Africa (20/41) and low-income countries (15/22). In 69% of countries, PD was the initial dialysis modality for≤10% of patients with newly diagnosed kidney failure. Patients receiving PD were expected to pay 1% to 25% of treatment costs, and higher (>75%) copayments (out-of-pocket expenses incurred by patients) were more common in South Asia and low-income countries. Average exchange volumes were adequate (defined as 3-4 exchanges per day or the equivalent for automated PD) in 72% of countries. PD quality outcome monitoring and reporting were variable. Most countries did not measure patient-reported PD outcomes.RESULTSResponses were received from 88% (n=160) of countries and there were 313 participants (257 nephrologists [82%], 22 non-nephrologist physicians [7%], 6 other health professionals [2%], 17 administrators/policy makers/civil servants [5%], and 11 others [4%]). 85% (n=156) of countries responded to questions about PD. Median PD use was 38.1 per million population. PD was not available in 30 of the 156 (19%) countries responding to PD-related questions, particularly in countries in Africa (20/41) and low-income countries (15/22). In 69% of countries, PD was the initial dialysis modality for≤10% of patients with newly diagnosed kidney failure. Patients receiving PD were expected to pay 1% to 25% of treatment costs, and higher (>75%) copayments (out-of-pocket expenses incurred by patients) were more common in South Asia and low-income countries. Average exchange volumes were adequate (defined as 3-4 exchanges per day or the equivalent for automated PD) in 72% of countries. PD quality outcome monitoring and reporting were variable. Most countries did not measure patient-reported PD outcomes.Low responses from policy makers; limited ability to provide more in-depth explanations underpinning outcomes from each country due to lack of granular data; lack of objective data.LIMITATIONSLow responses from policy makers; limited ability to provide more in-depth explanations underpinning outcomes from each country due to lack of granular data; lack of objective data.Large inter- and intraregional disparities exist in PD availability, accessibility, affordability, delivery, and reporting of quality outcome measures around the world, with the greatest gaps observed in Africa and South Asia.CONCLUSIONSLarge inter- and intraregional disparities exist in PD availability, accessibility, affordability, delivery, and reporting of quality outcome measures around the world, with the greatest gaps observed in Africa and South Asia. |
| Author | Harden, Paul Jager, Kitty J. Neuen, Brendon Zemchenkov, Alexander Tesar, Vladimir Tonelli, Marcello Cho, Yeoungjee Ghnaimat, Mohammad Johnson, David W. Caskey, Fergus J. Yee-Moon Wang, Angela Sola, Laura Saad, Syed Klarenbach, Scott Tchokhonelidze, Irma Jindal, Kailash K. Gharbi, Mohammed Benghanem Bello, Aminu K. Lunney, Meaghan Kerr, Peter G. Ashuntantang, Gloria E. Yang, Chih-Wei Harris, David C. Bellorin-Font, Ezequiel Kalantar-Zadeh, Kamyar Tungsanga, Kriang Davison, Sara N. Rashid, Harun Ur Levin, Adeera Osman, Mohamed A. Zhao, Ming-hui Ossareh, Shahrzad Ye, Feng Okpechi, Ikechi G. O’Donoghue, Donal Perl, Jeffrey Jha, Vivekanand Htay, Htay Rondeau, Eric Kovesdy, Csaba P. Kazancioglu, Rumeyza Turan See, Emily J. Luyckx, Valerie |
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Canada – sequence: 6 givenname: Feng surname: Ye fullname: Ye, Feng organization: Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada – sequence: 7 givenname: Gloria E. surname: Ashuntantang fullname: Ashuntantang, Gloria E. organization: Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde I, Yaounde, Cameroon – sequence: 8 givenname: Ezequiel surname: Bellorin-Font fullname: Bellorin-Font, Ezequiel organization: Division of Nephology and Hypertension, Department of Medicine, Saint Louis University, Saint Louis, MO – sequence: 9 givenname: Mohammed Benghanem surname: Gharbi fullname: Gharbi, Mohammed Benghanem organization: Urinary Tract Diseases Department, Faculty of Medicine and Pharmacy of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco – sequence: 10 givenname: Sara N. surname: Davison fullname: Davison, Sara N. organization: Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada – sequence: 11 givenname: Mohammad surname: Ghnaimat fullname: Ghnaimat, Mohammad organization: Nephrology Division, Department of Internal Medicine, The Specialty Hospital, Amman, Jordan – sequence: 12 givenname: Paul surname: Harden fullname: Harden, Paul organization: Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom – sequence: 13 givenname: Htay surname: Htay fullname: Htay, Htay organization: Department of Renal Medicine, Singapore General Hospital, Singapore – sequence: 14 givenname: Vivekanand surname: Jha fullname: Jha, Vivekanand organization: George Institute for Global Health, UNSW, New Delhi, India – sequence: 15 givenname: Kamyar surname: Kalantar-Zadeh fullname: Kalantar-Zadeh, Kamyar organization: Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA – sequence: 16 givenname: Peter G. surname: Kerr fullname: Kerr, Peter G. organization: Department of Nephrology, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia – sequence: 17 givenname: Scott surname: Klarenbach fullname: Klarenbach, Scott organization: Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada – sequence: 18 givenname: Csaba P. surname: Kovesdy fullname: Kovesdy, Csaba P. organization: University of Tennessee Health Science Center, Memphis, TN – sequence: 19 givenname: Valerie surname: Luyckx fullname: Luyckx, Valerie organization: Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Zurich, Switzerland – sequence: 20 givenname: Brendon surname: Neuen fullname: Neuen, Brendon organization: George Institute for Global Health, UNSW, New Delhi, India – sequence: 21 givenname: Donal surname: O’Donoghue fullname: O’Donoghue, Donal organization: Salford Royal NHS Foundation Trust, Salford, United Kingdom – sequence: 22 givenname: Shahrzad surname: Ossareh fullname: Ossareh, Shahrzad organization: Division of Nephrology, Department of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran – sequence: 23 givenname: Jeffrey surname: Perl fullname: Perl, Jeffrey organization: Division of Nephrology, St. Michael's Hospital and the Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada – sequence: 24 givenname: Harun Ur surname: Rashid fullname: Rashid, Harun Ur organization: Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh – sequence: 25 givenname: Eric surname: Rondeau fullname: Rondeau, Eric organization: Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France – sequence: 26 givenname: Emily J. surname: See fullname: See, Emily J. organization: Department of Intensive Care, Austin Health, Melbourne, Australia – sequence: 27 givenname: Syed surname: Saad fullname: Saad, Syed organization: Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada – sequence: 28 givenname: Laura surname: Sola fullname: Sola, Laura organization: Dialysis Unit, CASMU-IAMPP, Montevideo, Uruguay – sequence: 29 givenname: Irma surname: Tchokhonelidze fullname: Tchokhonelidze, Irma organization: Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia – sequence: 30 givenname: Vladimir surname: Tesar fullname: Tesar, Vladimir organization: Department of Nephrology, General University Hospital, Charles University, Prague, Czech Republic – sequence: 31 givenname: Kriang surname: Tungsanga fullname: Tungsanga, Kriang organization: Department of Medicine, Faculty of Medicine, King Chulalong Memorial Hospital, Chulalongkorn University, Bangkok, Thailand – sequence: 32 givenname: Rumeyza Turan surname: Kazancioglu fullname: Kazancioglu, Rumeyza Turan organization: Division of Nephrology, Bezmialem Vakif University, Istanbul, Turkey – sequence: 33 givenname: Angela surname: Yee-Moon Wang fullname: Yee-Moon Wang, Angela organization: Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong – sequence: 34 givenname: Chih-Wei surname: Yang fullname: Yang, Chih-Wei organization: Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan – sequence: 35 givenname: Alexander surname: Zemchenkov fullname: Zemchenkov, Alexander organization: Department of Internal Disease and Nephrology, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia – sequence: 36 givenname: Ming-hui surname: Zhao fullname: Zhao, Ming-hui organization: Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China – sequence: 37 givenname: Kitty J. surname: Jager fullname: Jager, Kitty J. organization: ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands – sequence: 38 givenname: Fergus J. surname: Caskey fullname: Caskey, Fergus J. organization: Population Health Sciences, University of Bristol, Bristol, United Kingdom – sequence: 39 givenname: Kailash K. surname: Jindal fullname: Jindal, Kailash K. organization: Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa – sequence: 40 givenname: Ikechi G. surname: Okpechi fullname: Okpechi, Ikechi G. organization: Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa – sequence: 41 givenname: Marcello surname: Tonelli fullname: Tonelli, Marcello organization: Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada – sequence: 42 givenname: David C. surname: Harris fullname: Harris, David C. organization: Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia – sequence: 43 givenname: David W. surname: Johnson fullname: Johnson, David W. organization: Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32800844$$D View this record in MEDLINE/PubMed |
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| Snippet | Approximately 11% of people with kidney failure worldwide are treated with peritoneal dialysis (PD). This study examined PD use and practice patterns across... |
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| SubjectTerms | access to health care Administrative Personnel affordability of health care Cost Sharing Costs and Cost Analysis Cross-Sectional Studies Delivery of Health Care Developed Countries Developing Countries end-stage renal disease (ESRD) Epidemiology global survey health care delivery health care disparities Health Expenditures Health Policy Health Services Accessibility home dialysis Humans international differences Internationality kidney failure Kidney Failure, Chronic - therapy Nephrologists Nephrology Outcome Assessment, Health Care Patient Reported Outcome Measures Peritoneal Dialysis peritoneal dialysis (PD) Physicians Practice Patterns, Physicians Quality of Health Care renal replacement therapy (RRT) RRT modality Surveys and Questionnaires |
| Title | Peritoneal Dialysis Use and Practice Patterns: An International Survey Study |
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