Epidemiology of peritoneal dialysis: a story of believers and nonbelievers

Lameire, Norbert; Biesen, Wim Van

doi:10.1038/nrneph.2009.210

Cited by 90 publications

(81 citation statements)

References 50 publications

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“…Our data suggest that it may make sense to recommend that patients receive more information and education about choice of modality before dialysis initiation. As was shown previously, when patients get educated about dialysis modalities, the number of patients who decide to initiate PD increases, and the level of satisfaction also increases with the choice of modality (24,25).…”

Section: Discussionsupporting

confidence: 55%

Comparing Mortality of Peritoneal and Hemodialysis Patients in the First 2 Years of Dialysis Therapy

Lukowsky

Mehrotra

Kheifets

et al. 2013

Clinical Journal of the American Society of Nephrology

147

101

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SummaryBackground and objectives There are conflicting research results about the survival differences between hemodialysis and peritoneal dialysis, especially during the first 2 years of dialysis treatment. Given the challenges of conducting randomized trials, differential rates of modality switch and transplantation, and time-varying confounding in cohort data during the first years of dialysis treatment, use of novel analytical techniques in observational cohorts can help examine the peritoneal dialysis versus hemodialysis survival discrepancy.Design, setting, participants, & measurements This study examined a cohort of incident dialysis patients who initiated dialysis in DaVita dialysis facilities between July of 2001 and June of 2004 and were followed for 24 months. This study used the causal modeling technique of marginal structural models to examine the survival differences between peritoneal dialysis and hemodialysis over the first 24 months, accounting for modality change, differential transplantation rates, and detailed time-varying laboratory measurements.Results On dialysis treatment day 90, there were 23,718 incident dialysis-22,360 hemodialysis and 1,358 peritoneal dialysis-patients. Incident peritoneal dialysis patients were younger, had fewer comorbidities, and were nine and three times more likely to switch dialysis modality and receive kidney transplantation over the 2-year period, respectively, compared with hemodialysis patients. In marginal structural models analyses, peritoneal dialysis was associated with persistently greater survival independent of the known confounders, including dialysis modality switch and transplant censorship (i.e., death hazard ratio of 0.52 [95% confidence limit 0.34-0.80]).Conclusions Peritoneal dialysis seems to be associated with 48% lower mortality than hemodialysis over the first 2 years of dialysis therapy independent of modality switches or differential transplantation rates.

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Section: Discussionsupporting

confidence: 55%

Comparing Mortality of Peritoneal and Hemodialysis Patients in the First 2 Years of Dialysis Therapy

Lukowsky

Mehrotra

Kheifets

et al. 2013

Clinical Journal of the American Society of Nephrology

147

101

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“…This decline in PD use has been noted by others and may be explained by a few factors. 3,[15][16][17]23,24 Several economic influences, including health care financing and delivery, physician reimbursement, and resource availability, have been suggested to affect trends in use. 3 For example, countries with private dialysis providers generally use PD for a smaller proportion of dialysis patients than countries in which public providers dominate.…”

Section: Resultsmentioning

confidence: 99%

“…However, studies that showed declining PD use in the developed world are limited by the number of countries considered and the length of time examined. 3,[15][16][17] No study has examined the global use of different PD modalities over a significant period of time, including continuous ambulatory PD (CAPD) and automated PD (APD). For these reasons, we assessed PD use worldwide by compiling data from multiple sources over a 12-year period.…”

Section: Introductionmentioning

confidence: 99%

Global Trends in Rates of Peritoneal Dialysis

Jain

Blake²,

Cordy³

et al. 2012

Journal of the American Society of Nephrology

460

403

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Although there is a perception that the use of peritoneal dialysis is declining worldwide, compilations of global data are unavailable to test this hypothesis. We assessed longitudinal trends in the use of peritoneal dialysis from 1997 to 2008 in 130 countries. The preferred data sources were renal registries, followed by nephrology societies, health ministries, academic centers, national experts, and industry affiliates. In 2008, there were approximately 196,000 peritoneal dialysis patients worldwide, representing 11% of the dialysis population. In total, 59% were treated in developing countries and 41% in developed countries. Over 12 years, the number of peritoneal dialysis patients increased in developing countries by 24.9 patients per million population and in developed countries by 21.8 per million population. The proportion of all dialysis patients treated with peritoneal dialysis did not change in developing countries but significantly declined in developed countries by 5.3%. The use of automated peritoneal dialysis increased by 14.5% in developing countries and by 30.3% in developed countries. In summary, the number of patients treated with peritoneal dialysis rose worldwide from 1997 to 2008, with a 2.5-fold increase in the prevalence of peritoneal dialysis patients in developing countries. The proportion of all dialysis patients treated with this modality continues to decline in developed countries. Chronic dialysis is a life-sustaining treatment for patients with ESRD. Access to dialysis remains limited in several regions of the world due to a lack of financial and clinical resources. [1][2][3][4][5][6][7][8][9] As countries look to develop dialysis programs to manage the growing burden of ESRD, it is important to place patterns of peritoneal dialysis (PD) use in the global context. This information is particularly helpful to individuals in member nations responsible for health care delivery to evaluate their PD programs through comparisons with countries of similar socioeconomic structure.A comprehensive global assessment of PD use to date has been lacking. One study suggested that 11% of chronic dialysis patients around the world are treated with PD. 10 Several renal registries report PD use at a national and regional level, 11-14 but not on a global scale. There is a perception that PD use is declining worldwide. However, studies that showed declining PD use in the developed world are limited by the number of countries considered and the length of time examined. 3,[15][16][17] No study has examined the global use of different PD modalities over a significant period of time, including continuous ambulatory PD (CAPD) and automated PD (APD). For these reasons, we assessed PD use worldwide by compiling data from multiple sources over a 12-year period. We examined the trends in PD use across developing and developed nations, focusing on crude numbers, prevalence per million population, and the proportion of dialysis patients who received PD. We hypothesized an increasing PD prevalence in the dev...

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“…The prevalence of PD has been previously associated with reimbursement patterns (26). Some countries and states provide incentives for increasing the proportion of patients who use PD within publicly funded systems (25,27).…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic Differences in the Uptake of Home Dialysis

Grace

Clayton

Gray

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Home dialysis creates fewer lifestyle disruptions while providing similar or better outcomes than in-center hemodialysis. Socioeconomically advantaged patients are more likely to commence home dialysis (peritoneal dialysis and home hemodialysis) in many developed countries. This study investigated associations between socioeconomic status and uptake of home dialysis in Australia, a country with universal access to health care and comparatively high rates of home dialysis.

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Epidemiology of peritoneal dialysis: a story of believers and nonbelievers

Cited by 90 publications

References 50 publications

Comparing Mortality of Peritoneal and Hemodialysis Patients in the First 2 Years of Dialysis Therapy

Comparing Mortality of Peritoneal and Hemodialysis Patients in the First 2 Years of Dialysis Therapy

Global Trends in Rates of Peritoneal Dialysis

Socioeconomic Differences in the Uptake of Home Dialysis

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