title: Home visit program improves technique survival in peritoneal dialysis.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Nephrology, Dialysis, and Kidney Transplant, San Bortolo Hospital, Vicenza, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Martino
authors.forename: Z
authors.initials: Z
authors.lastname: Adıbelli
authors.forename: G
authors.initials: G
authors.lastname: Mason
authors.forename: A
authors.initials: A
authors.lastname: Nayak
authors.forename: W
authors.initials: W
authors.lastname: Ariyanon
authors.forename: E
authors.initials: E
authors.lastname: Rettore
authors.forename: Carlo
authors.initials: C
authors.lastname: Crepaldi
authors.forename: Mariapia
authors.initials: M
authors.lastname: Rodighiero
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006437:Hemodialysis, Home; D006792:House Calls; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000209:etiology / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome