Abstract: PO1322
Patient Characteristics and Frequency of Prescription (Rx) Alterations in Automated Peritoneal Dialysis (APD)
Session Information
- Peritoneal Dialysis - 2
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 703 Dialysis: Peritoneal Dialysis
Authors
- Giles, Harold E., Nephrology Associates PC, Birmingham, Alabama, United States
- Parameswaran, Vidhya, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
- Ficociello, Linda, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
- Mullon, Claudy, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
- Chatoth, Dinesh K., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Anger, Michael S., Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
- Kossmann, Robert J., Fresenius Medical Care North America, Waltham, Massachusetts, United States
Background
APD provides the flexibility to adapt PD Rx to the needs, lifestyle, and health status of a patient (e.g. residual renal function [Kru], volume and transport status). The alterations may include changes in dwell volumes, dwell times, or number of exchanges. The current analysis aims to describe frequency of APD Rx alterations and patient (pt) characteristics associated with these alterations
Methods
All de-identified demographic, lab, and Rx data were extracted from Fresenius Kidney Care clinical data warehouse. Adults who were incident to APD from 01/01/2015 to 12/31/2019, completed APD training and >1 treatments,and had no change in PD modality or data quality issues with their records were included. Any change in dwell volumes, dwell times, or number of exchanges was considered an alteration. Characteristics of the pts in the month leading up to their most recent alteration were described and stratified by the number of Rx alterations they received at followup.
Results
15,237 pts were eligible for inclusion. The majority (72.7%) of pts had >1 PD Rx alterations during a mean follow-up time of 418 days (compared to 201-day follow-up for pts with 0 alterations). Most pts (53%) had dwell volumes adjusted, with 52%, 4%, and 44% having increases, decreases, or both increases and decreases in dwell volume, respectively. The table details pt characteristics prior to alteration by frequency of Rx alterations.
Conclusion
Compared to pts with no Rx alterations, pts with more Rx alterations were heavier, had higher serum phosphorus, lower PD Kt/V, and lower Kru. The number of alterations along with the timing and direction of these changes need to be further studied to help determine if a pattern of changes is associated with risk of PD technique failure and switch to HD.
| Number of Rx alterations | n (%) Patients | Systolic Blood Pressure, mmHg | Diastolic Blood Pressure, mmHg | Weight, kg | PD Kt/V | Residual Kidney function ml/min/1.73 m2 | Serum phosphorus, mg/dL | Serum albumin, g/dL |
| 0 | 4,160 (27.3%) | 142 ± 25 | 81 ± 14 | 86.2 ± 24.4 | 2.4 ± 0.7 | 4.6 ± 3.5 | 5.4 ± 1.6 | 3.5 ± 0.5 |
| 1 | 3,603 (23.6%) | 139 ± 24 | 81 ± 15 | 85.8 ± 23.9 | 2.3 ± 0.7** | 4.1 ± 3.5** | 5.5 ± 1.6 | 3.5 ± 0.5* |
| 2 | 2,625 (17.2%) | 139 ± 26** | 80 ± 15 | 86.4 ± 23.5 | 2.2 ± 0.7** | 3.6 ± 3.2** | 5.6 ± 1.7** | 3.5 ± 0.5* |
| 3 | 1,743 (11.4%) | 139 ± 25** | 81 ± 15 | 87.3 ± 24.2 | 2.2 ± 0.6** | 3.3 ± 3.2** | 5.6 ± 1.7** | 3.5 ± 0.5* |
| 4 | 1,193 (7.8%) | 137 ± 25** | 80 ± 15 | 87.8 ± 23.0* | 2.2 ± 0.6** | 3.0 ± 3.2** | 5.8 ± 1.8** | 3.5 ± 0.5 |
| 5 | 742 (4.9%) | 136 ± 26** | 80 ± 14 | 88.6 ± 25.1* | 2.1 ± 0.6** | 2.9 ± 4.9** | 5.8 ± 1.8** | 3.5 ± 0.5 |
| 6 - 10 | 1,098 (7.2%) | 136 ± 26** | 80 ± 15 | 88.4 ± 23.5* | 2.1 ± 0.6** | 2.3 ± 2.8** | 5.9 ± 1.8** | 3.5 ± 0.5* |
| > 10 | 73 (0.5%) | 138 ± 28* | 79 ± 15 | 92.9 ± 22.7* | 1.9 ± 0.3** | 1.3 ± 1.5** | 6.0 ± 1.8 | 3.5 ± 0.4 |
| P | N/A | <0.001 | 0.8 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 |
** P<0.001; * P<0.05
Funding
- Commercial Support – Fresenius Medical Care Renal Therapies Group