Assisted peritoneal dialysis performed by caregivers and its association with patient outcomes

Abstract

Background: Although caregivers allow peritoneal dialysis (PD) patients with disabilities the opportunity to perform PD, it is crucial to clarify the safety and effectiveness of assisted PD performed by caregivers compared to self-PD. Methods: PD patients from 22 PD centres in Thailand were prospectively followed in the Peritoneal Dialysis Outcomes and Practice Patterns Study during 2016–2017. Patients receiving assisted PD performed by caregivers were matched 1:1 with self-PD patients using propensity scores calculated by logistic regression. The associations between assisted PD and risk of mortality, peritonitis and permanent transfer to haemodialysis (HD) were assessed by multivariable competing risk regression. Results: Of 778 eligible patients, 447 (57%) required assisted PD performed by caregivers. Most of the caregivers were family members (98%), while the rest were non-family paid caregivers (2%). Patient factors associated with assisted PD were older age, female gender, lower educational level, cardiovascular comorbidities, diabetes, automated PD modality, poorer functional status and lower blood chemistries (albumin, creatinine, sodium, potassium and phosphate). After 1:1 matching, the baseline characteristics were adequately matched, and 269 patients in each group were analysed. Compared with self-PD, assisted PD was significantly associated with an increased risk of all-cause mortality (adjusted sub-hazard ratio: 2.15, 95% confidence interval: 1.24–3.74). There were no differences in the occurrences of peritonitis and permanent HD transfer between the groups. Conclusions: Assisted PD was required by more than half of Thai PD patients and was independently associated with a higher mortality risk. This may reflect causal effect or confounding by indication.

Enhancing healthcare quality and outcomes for peritoneal dialysis patients in Thailand: An evaluation of key performance indicators and PDOPPS cohort representativeness

“…A random sample of prevalent and incident adult patients older than 18 years, who were receiving chronic PD, were enrolled within each randomly selected PD centre. The objectives, design, methodology, and outcomes of the international and Thailand PDOPPS have been previously documented 6–10 …”

“…This cohort provides comprehensive and high‐quality data using standardised clinical tools and validated processes to ensure research‐level data quality. Since May 2016, Thailand has actively participated in the PDOPPS (Thai PDOPPS), and data collection is ongoing, and the results are flourishing 6–10 …”

“…Since May 2016, Thailand has actively participated in the PDOPPS (Thai PDOPPS), and data collection is ongoing, and the results are flourishing. [6][7][8][9][10] In this study, we aimed to determine whether the PD centres included in the Thai PDOPPS had comparable infrastructure, workforce capacities, and outcomes to other PD centres not included in the PDOPPS, using data from the national Thai PD KPIs surveillance database. Additionally, analysing the database was able to provide valuable insights into the practices and challenges encountered by PD centres in Thailand with diverse workforces, experiences, infrastructure, and support, as well as identify opportunities for improvement.…”

Dialysis and kidney transplant practices and challenges in Thailand

“…Over one‐half of Thai PD patients require caregivers to assist with their PD exchanges (60%), which likely reflects the high prevalence of functional impairment in PD patients (47%) 13,18 . Patients who persistently or subsequently require caregivers to assist with PD exchange are associated with increased mortality risk, but not with peritonitis or HD transfer risk, compared with patients who never need PD caregivers 19 …”

“…13,18 Patients who persistently or subsequently require caregivers to assist with PD exchange are associated with increased mortality risk, but not with peritonitis or HD transfer risk, compared with patients who never need PD caregivers. 19 Peritonitis is the leading cause of HD transfer and death in Thai PD patients. The crude peritonitis rate was 0.39 episodes/year and at the upper end of the range reported in PDOPPS (0.28-0.40 episodes/ year) 11 and complying with the 2022 International Society for PD (ISPD) guidelines target of below 0.4 episodes/year.…”