Speaker highlights reasons for peritoneal dialysis dropout
KANSAS CITY, Mo. — A peritoneal dialysis program is not only successful when it attracts new patients to the therapy, but is able to increase technique survival, which keeps patients on the therapy with as few complications as possible.
“It is important to build a strong team,” in helping to maintain patients on PD, Anjay Rastogi, MD, PhD, professor and clinical chief and director of the dialysis program in the division of nephrology in the department of medicine at the David Geffen School of Medicine at University of California, Los Angeles (UCLA) Health, told attendees at the Annual Dialysis Conference, here.
While his program includes 150 patients on home dialysis and continues to grow, more importantly, “I can count on one hand our dropout rate [for technique failure],” Rastogi said. UCLA performed 450 kidney transplants in 2019, and many patients on PD took that option.
“I don’t see transplants as losses” to the home therapy program, he said. “We have had patients on PD for 6 years to 9 years, and they are doing very well.”
High retention in a PD program creates volume, and Rastogi said staff experience with larger groups — 30 to 50 patients — leads to better technique survival. Importantly, a successful program starts with the right leadership.
“You have to get the right medical director who truly believes in home modalities. He needs to be a true champion and leader of your program,” he said.
PD can have complications, too, Rastogi said, and identifying these issues proactively can help reduce the risk of dropout. Key issues include infections, particularly peritonitis, hospitalizations, catheter dysfunction and psychosocial factors.
Rastogi’s presentation was part of a day-long symposium at the conference that included debates and discussion about achieving the Advancing American Kidney Health goal, which requires nephrologists and dialysis providers to start 80% of new patients on either home dialysis or have a functioning kidney transplant by 2025.
Creating retention in a home dialysis program includes several steps, Rastogi said. It is important that staff build a level of trust with patients and continuously maintain dialogue about how their therapy is progressing. Patient selection is also important, along with understanding the right time to discuss switching to home hemodialysis.
Pre-ESRD education is also key.
“That is the best way we have found to avoid urgent starts,” on dialysis, Rastogi said. “Education must continue throughout the therapy; don’t forget the family and the caregivers,” he said. - by Mark E. Neumann
Rastogi A. Common reasons for PD dropout and how to overcome these challenges. Presented at: The Annual Dialysis Conference; Feb. 8-11, 2020; Kansas City, Missouri.
Disclosure: Rastogi reports no relevant financial disclosures.