Barriers to Peritoneal Dialysis in Saskatchewan Canada: Results From a Province-Wide Survey

Abstract

Background: Peritoneal dialysis (PD) is an underutilized, therapeutic option to in-center hemodialysis (HD), given its similar survival and clinical efficacy but provides lifestyle benefits and cost savings. Despite these advantages, PD prevalence rates remains below 20% in many Canadian jurisdictions. Objectives: The primary objective of this study was to identify and assess patient-perceived barriers to PD implementation in Saskatchewan. The secondary objectives were to examine variations in patient-perceived barriers to PD by dialysis units (main dialysis units vs satellite dialysis units) and specific challenges faced by First Nation patients residing on reserves. Design: A cross-sectional observational survey study. Setting: Two major centers (Regina and Saskatoon) and 5 associated satellite units attached to each center across the province of Saskatchewan. Patients: We approached all prevalent in-center HD patients across Saskatchewan, 366 (49%) agreed to participate in the study. Measurements: Self-reported barriers to PD were assessed using a 26-question survey which was created after engagement of our multidisciplinary team. Methods: We conducted a cross-sectional survey of 740 prevalent in-center HD patients within the province of Saskatchewan, Canada, from June 2018 to January 2019. Around 366 (49%) patients agreed to participate in the study. The questionnaire was designed to capture patients’ perceived barriers to PD. Descriptive statistics were used to present the data. Chi-square and Mann-Whitney U-test were used to compare the patients’ responses (main dialysis units vs satellite dialysis units, and First Nation reserves vs nonreserves). Results: Of the 366 patients who completed the survey, 284 met the eligibility criteria and were included in the analysis. Patient-reported satisfaction with current in-center HD care was the most common barrier to PD uptake (92%), followed by proximity to their HD unit (61%). A lack of understanding of the benefits/risks of PD, fear of family burden (54% each), and unwillingness to dialyze daily and to learn a new technique (51% each) were additional factors. Patients residing on reserves compared to nonreserve residents felt PD had a higher risk of infection compared to HD (54% vs 34%, P = .005), and felt PD led to suboptimal care (47% vs 31%, P = .021). Limitations: We used a nonstandardized locally derived questionnaire to quantify barriers, and this prevents inclusion of additional barriers than individual patients may consider important. Cross-sectional data can only be used as a snapshot. Only 366 patients agreed to participate, and the results cannot be generalized to 740 prevalent HD patients. We did not capture data on demographics (age, income, and literacy level), comorbidities, and dialysis vintage, which would have been helpful in interpretation of the results. We did not involve patients, carers, or patients of First Nations heritage, in the design of the survey and the study. Conclusions: The results of our survey indicate that the major patient-reported barrier to PD uptake in our province is clinical inertia in patients defaulted to in-center HD at the onset of dialysis. Lack of patient awareness and knowledge of PD as a viable treatment modality also figured prominently, as did fears/concerns surrounding the safety, efficacy, and perceived family burden with PD compared with in-center HD. Trial Registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

YouTube as a platform for knowledge and awareness of peritoneal dialysis: A content analysis

“…PD provides several advantages over HD via assuring RKF, haemodynamic stability, flexibility and autonomy, less restricted diet and averting the need for vascular access. 3,22 Even though it has a plethora of advantages, most patients who need maintenance KRT avoid PD. Prasad et al found in a multicentre cross-sectional observational survey study that the main patient-reported barriers to PD were lack of awareness and knowledge about PD and fears surrounding safety and efficacy.…”

“…Studies adjusted for comorbidities have found no mortality differences or better survival with PD than HD. 3 However, PD mortality decreased in the last decade due to biocompatible solutions and advances in PD technologies. 4,5 Furthermore, PD provides several advantages over HD, including preserving residual kidney function (RKF), haemodynamic stability, autonomy and flexibility.…”

“…4,5 Furthermore, PD provides several advantages over HD, including preserving residual kidney function (RKF), haemodynamic stability, autonomy and flexibility. 3 Despite these positive contributions to the quality of life and survival, the prevalence of PD lags far behind HD. One of the main barriers to increasing PD is the lack of patient awareness and knowledge of PD as a maintenance dialysis modality.…”

“…One of the main barriers to increasing PD is the lack of patient awareness and knowledge of PD as a maintenance dialysis modality. 3 Therefore, any intervention that can make patients realise that PD is a maintenance KRT that offers certain advantages is essential.…”

Program Report: Nîsohkamâtowak—Helping Patients and Families Living With Kidney Disease in Northern Saskatchewan

“…The reasons for the disparity in utilization and the barriers to home dialysis in First Nations communities in Saskatchewan need to be addressed to improve quality of care. 15 …”