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Patient-reported advantages and disadvantages of peritoneal dialysis: results from the PDOPPS

Authors
  • Sukul, Nidhi1
  • Zhao, Junhui2
  • Fuller, Douglas S.2
  • Karaboyas, Angelo2
  • Bieber, Brian2
  • Sloand, James A.3
  • Subramanian, Lalita2
  • Johnson, David W.4
  • Oliver, Matthew J.5
  • Tungsanga, Kriang6
  • Tomo, Tadashi7
  • Morton, Rachael L.8
  • Morgenstern, Hal9
  • Robinson, Bruce M.2
  • Perl, Jeffrey10
  • 1 Michigan Medicine, 1500 E. Medical Center Dr., SPC 5364, Ann Arbor, Michigan, 48109-5364, USA , Ann Arbor (United States)
  • 2 Arbor Research Collaborative for Health, Ann Arbor, MI, USA , Ann Arbor (United States)
  • 3 Baxter Healthcare Corporation, Deerfield, IL, USA , Deerfield (United States)
  • 4 University of Queensland at Princess Alexandra Hospital, Centre for Kidney Disease Research, Brisbane, QLD, Australia , Brisbane (Australia)
  • 5 Sunnybrook Health Sciences Centre, Toronto, ON, Canada , Toronto (Canada)
  • 6 King Chulalongkorn Memorial Hospital, Bangkok, Thailand , Bangkok (Thailand)
  • 7 Oita University Hospital, Yufu, Japan , Yufu (Japan)
  • 8 The University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia , Sydney (Australia)
  • 9 Medical School, University of Michigan, Departments of Epidemiology and Environmental Health Sciences, School of Public Health, and Department of Urology, Ann Arbor, MI, USA , Ann Arbor (United States)
  • 10 St. Michael’s Hospital, Toronto, ON, Canada , Toronto (Canada)
Type
Published Article
Journal
BMC Nephrology
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Apr 02, 2019
Volume
20
Issue
1
Identifiers
DOI: 10.1186/s12882-019-1304-3
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundPatient-reported measures are increasingly recognized as important predictors of clinical outcomes in peritoneal dialysis (PD). We sought to understand associations between patient-reported perceptions of the advantages and disadvantages of PD and clinical outcomes.MethodsIn this cohort study, 2760 PD patients in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) completed a questionnaire on their PD experience, between 2014 and 2017. In this questionnaire, PDOPPS patients rated 17 aspects of their PD experience on a 5-category ordinal scale, with responses scored from − 2 (major disadvantage) to + 2 (major advantage). An advantage/disadvantage score (ADS) was computed for each patient by averaging their response scores. The ADS, along with each of these 17 aspects, were used as exposures. Outcomes included mortality, transition to hemodialysis (HD), patient-reported quality of life (QOL), and depression. Cox regression was used to estimate associations between ADS and mortality, transition to HD, and a composite of the two. Logistic regression with generalized estimating equations was used to estimate cross-sectional associations of ADS with QOL and depression.ResultsWhile 7% of PD patients had an ADS < 0 (negative perception of PD), 59% had an ADS between 0 and < 1 (positive perception), and 34% had an ADS ≥1 (very positive perception). Minimal association was observed between mortality and the ADS. Compared with a very positive perception, patients with a negative perception had a higher transition rate to HD (hazard ratio [HR] = 1.67; 95% confidence interval [CI]: 1.21, 2.30). Among individual items, “space taken up by PD supplies” was commonly rated as a disadvantage and had the strongest association with transition to HD (HR = 1.28; 95% CI 1.07, 1.53). Lower ADS was strongly associated with worse QOL rating and greater depressive symptoms.ConclusionsAlthough patients reported a generally favorable perception of PD, patient-reported disadvantages were associated with transition to HD, lower QOL, and depression. Strategies addressing these disadvantages, in particular reducing solution storage space, may improve patient outcomes and the experience of PD.

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