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Kidney Week

Abstract: SA-PO629

Provider Peritoneal Dialysis (PD) Education Can Increase Continuous Ambulatory Peritoneal Dialysis (CAPD) Utilization Without Increased Peritonitis

Session Information

  • Home Dialysis - II
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Kraus, Michael A., Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
  • Lasky, Rachel A., Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
  • Ficociello, Linda, Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
  • Fisher, Edward C., Metrolina Nephrology, Charlotte, North Carolina, United States
  • Hussein, Usama T., Nephrology Associates of Tidewater LTD, Norfolk, Virginia, United States
  • Cabrera, Lisa O., Renal Associates PA, San Antonio, Texas, United States
  • Thomas, Rajesh, Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
  • Waiblinger, Patricia, Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
Background

CAPD use is low (<10%) in the US and Automated Peritoneal Dialysis (APD) is the preferred modality of PD (Peritoneal Dialysis). There are many reasons for increased APD utilization, but the perceived bias of healthcare providers toward CAPD may be a driver. CAPD is presumed to have greater burden and higher peritonitis rates, but APD may have greater complexity, more frequent alarms, storage needs, and time attached to a machine. We hypothesized that an education program on the physiology of PD, benefits of CAPD, monitoring KPIs (key performance indicators), and thrice daily exchanges on initiation with ongoing support would increase CAPD utilization without increasing peritonitis rates.

Methods

The program was implemented between 7/22 and 11/22 in 17 Fresenius Kidney Care home units across 3 established PD markets with variable CAPD utilization (7%(I), 13%(II) and 19%(III)). Adults who started PD between 2/22 and 4/23 were included. Outcomes reviewed include new CAPD starts, peritonitis rates, and conversion to hemodialysis (HD) therapy during the five months before and five months after participation in the pilot program.

Results

215 patients started CAPD during the analysis period. CAPD starts increased from 59% of all new starts (n=111) in the 5 months prior to pilot start to 79% (n=104, p=0.0003) during the initial 5 months of the pilot. Conversion from CAPD to APD declined from 20/111, 18%, to 5/104, 4.8%, from the two periods. 100% of conversions were from a single market (I). Overall CAPD penetration rose in every market (I-61%, II-32%, III-30%) and 36% overall. Peritonitis rates among the new starts improved in the CAPD group, but not in the CCPD group. CAPD group peritonitis rates decreased significantly from 1/32.5 patient months to 1/238 patient months (RR=0.13, p=0.03). CCPD peritonitis rates increased with new starts from 1/55 patient months to 1/40.7 patient months, but the difference was not significant. The rate of conversion to HD remained consistent between the two time periods.

Conclusion

CAPD may offer advantages to many patients in the USA and may be underutilized. Education on PD physiology, potential benefits of CAPD, initiation awareness programs, and ongoing support with review of KPIs can lead to greater utilization of CAPD without an increased peritonitis risk.

Funding

  • Commercial Support – Fresenius Medical Care