title: Evaluation of a 12-Month Pilot of Long-Term and Temporary Assisted Peritoneal Dialysis.
abstract: ♦ BACKGROUND: Peritoneal dialysis (PD) is challenging for patients with functional limitations, and assisted PD can support these patients, but previous reports of assisted PD have not examined the role of temporary assisted PD and had difficulty identifying adequate comparator cohorts. ♦ METHODS: Peritoneal Dialysis Assist (PDA), a 12-month pilot of long-term and temporary assisted PD was completed in multiple PD centers in British Columbia, Canada. Continuous cycler PD (CCPD) patients were identified for PDA by standardized criteria, and service could be long-term or temporary/respite. The PDA program provided daily assistance with cycler dismantle and setup, but patients remained responsible for cycler connections and treatment decisions. Outcomes were compared against both the general CCPD population and patients who met PDA criteria but were not enrolled (PDA-eligible). ♦ RESULTS: Fifty-three PDA patients had an 88% 1-year death- and transplant-censored technique survival that was similar to the general CCPD cohort (84%) and PDA-eligible cohort (86%). The PDA cohort had lower peritonitis rates (0.18 episodes/patient-year vs 0.22 and 0.36, respectively), but higher hospitalization (55% vs 34% and 35%, respectively). Long-term PDA cost approximately CDN$15,000/year in addition to existing dialysis costs. A total of 8/11 respite PDA patients (73%) returned to self-care PD after a median PDA use of 29 days, which costs $1,250/patient. ♦ CONCLUSIONS: Peritoneal Dialysis Assist provides effective support to functionally-limited CCPD patients and yields acceptable clinical outcomes. The program costs less than transfer to HD or long-term care, which represents cost minimization for failing self-care PD patients. Respite PDA provides effective temporary support; most patients returned to self-care PD and service was cost-effective compared with alternatives of hospitalization or transfer to HD.
authors.affiliation: Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada mike.bevilacqua@bcpra.ca.|British Columbia Provincial Renal Agency, Vancouver, BC, Canada.
authors.forename: Micheli U
authors.initials: MU
authors.lastname: Bevilacqua
authors.affiliation: British Columbia Provincial Renal Agency, Vancouver, BC, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Turnbull
authors.affiliation: British Columbia Provincial Renal Agency, Vancouver, BC, Canada.
authors.forename: Sushila
authors.initials: S
authors.lastname: Saunders
authors.affiliation: British Columbia Provincial Renal Agency, Vancouver, BC, Canada.
authors.forename: Lee
authors.initials: L
authors.lastname: Er
authors.affiliation: British Columbia Provincial Renal Agency, Vancouver, BC, Canada.
authors.forename: Helen
authors.initials: H
authors.lastname: Chiu
authors.affiliation: British Columbia Provincial Renal Agency, Vancouver, BC, Canada.
authors.forename: Penny
authors.initials: P
authors.lastname: Hill
authors.affiliation: Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Rajinder S
authors.initials: RS
authors.lastname: Singh
authors.affiliation: Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.|British Columbia Provincial Renal Agency, Vancouver, BC, Canada.
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
authors.affiliation: Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Copland
authors.affiliation: Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Abeed
authors.initials: A
authors.lastname: Jamal
authors.affiliation: Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Brumby
authors.affiliation: Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Orla
authors.initials: O
authors.lastname: Dunne
authors.affiliation: Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Taylor
mesh_terms: D000368:Aged; D001955:British Columbia / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000401:mortality / Q000628:therapy*; D008297:Male; D010530:Peritoneal Dialysis / Q000379:methods*; D010865:Pilot Projects; D012648:Self Care / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Assisted peritoneal dialysis; economic analysis; home care services; respite support