Health Outcomes and Cost Considerations of Assisted Peritoneal Dialysis: A Narrative Review

Abstract

Background: Peritoneal dialysis (PD) is underutilized in many parts of the world despite pro-PD health policies. The physical and cognitive demands of PD means that over half of eligible patients require some form of assistance. As such, many countries now offer assisted PD (aPD) programs to help patients start or stay on PD as opposed to in-center hemodialysis (HD). In order to evaluate the potential scope of aPD, it is important to review the outcomes and cost considerations of aPD. Summary: We reviewed available data from different countries and regions for health outcomes between aPD and in-center HD, with a focus on quality of life (QoL), mortality, hospitalization, and technique survival. We also evaluated studies discussing the overall costs of delivering aPD, including training, operating costs, and indirect costs and compared these to in-center HD costs for the same regions. Key Messages: aPD patients are older and more frail than either self-care PD patients and many in-center HD patients. We found no evidence for any difference in QoL, mortality, or hospitalization between aPD and in-center HD after adjustment for these differences. There is some evidence for an association between nurse assistance and improved technique survival as compared to family assistance or self-care PD. Despite increased cost of providing assistance in PD, it is still significantly less expensive than in-center HD in Western Europe and Canada.

Epidemiology of peritoneal dialysis outcomes

“…However, in a systematic review of 34 non-randomized studies involving 46,597 participants from 20 jurisdictions, the relative efficacy and safety of assisted PD were uncertain, owing to highly variable study quality and markedly heterogeneous reported outcomes 235 . Similarly, a 2021 narrative review concluded that a difference in QOL, mortality or hospitalization between patients on assisted PD and those on facility HD was uncertain, after adjusting for the fact that patients receiving assisted PD were older and more frail 236 . Of note, assisted PD was significantly cheaper than facility HD in Canada and Western Europe 236 .…”

“…Similarly, a 2021 narrative review concluded that a difference in QOL, mortality or hospitalization between patients on assisted PD and those on facility HD was uncertain, after adjusting for the fact that patients receiving assisted PD were older and more frail 236 . Of note, assisted PD was significantly cheaper than facility HD in Canada and Western Europe 236 .…”

Peritoneal Dialysis for Potential Kidney Transplant Recipients: Pride or Prejudice?

“…However, an annual per patient saving of about 15000 USD and reduced costs for patients switching from PD to ICHD compared to those remaining on ICHD have been reported [213,214]. Certainly, it would be relevant to evaluate, with properly designed economic health-related studies, the costs of hospital admissions and hospital attendances for vascular accesses vs PD catheters procedures and complications [215].…”

Automated Peritoneal Dialysis: Patient Perspectives and Outcomes

“…33 PD utilization increased to some extent where aPD has been offered, and clinical outcomes and QoL appears to be at least as good as those of matched patients on in-center hemodialysis (iHD). [34][35][36] Technique Success and Patient Survival APD has the potential to serve patients at least as long as CAPD, and even longer in patients with no RKF and fast transport status, as well as those being (or near to become) dependent on a caregiver. Published studies on technique and patient survival with APD in comparison with CAPD produced conflicting results.…”