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. 2024 Jun 1;19(6):723-731.
doi: 10.2215/CJN.0000000000000436. Epub 2024 Feb 19.

Trends in Automated Peritoneal Dialysis Prescriptions in a Large Dialysis Organization in the United States

Harold E Giles  1   2 , Vidhya Parameswaran  3 , Rachel Lasky  3 , Linda H Ficociello  3 , Claudy Mullon  3 , Dinesh K Chatoth  3 , Michael Kraus  3 , Michael S Anger  3
Affiliations

Trends in Automated Peritoneal Dialysis Prescriptions in a Large Dialysis Organization in the United States

Harold E Giles et al. Clin J Am Soc Nephrol. .

Abstract

Key Points:

  1. This is the largest analysis of incident automated peritoneal dialysis (PD) prescriptions conducted in the United States to date.

  2. There was limited variability of automated PD prescriptions across the first 4 months of therapy.

  3. PD prescriptions tailored to meet the dialysis needs and lifestyle of patients may make PD a more attractive choice and increase longevity on PD.

Background: Changes in health care policies and recognition of patient benefit have contributed to increases in home-based dialysis, including peritoneal dialysis (PD). Frequent monitoring and early individualization of PD prescriptions are key prerequisites for the delivery of high-quality PD. The present analysis aimed to assess variations in PD prescriptions among incident automated PD (APD) patients who remain on PD for 120+ days.

Methods: This retrospective analysis examined data from patients within a large dialysis organization that initiated PD with APD between 2015 and 2019. PD prescription data were described by calendar year, timing of PD, and residual renal function categories. Changes in prescriptions from PD initiation (day 1) to day 120 were assessed descriptively.

Results: The cohort included 11,659 patients. The mean age at PD initiation increased from 2015 (56 [15] years) through 2019 (58 [15] years), whereas most other variables demonstrated no clear temporal change. Most patients (86%) had nighttime PD prescribed, with an average of 4.9 (1.3) cycles per day, a mean total treatment volume of 9.3 (2.5) L, and a median daily total dwell time of 7 (6–9.5) hours. Relative to day 1 nighttime prescriptions, there were (1) small increases in the proportion of patients receiving three or fewer cycles per day and those receiving 6+ cycles per day, (2) a 100 ml mean increase in fill volume per exchange, and (3) a mean 0.5 L increase in total nighttime treatment volume at day 120. When changes in nighttime APD prescriptions were examined at the patient level, 49% of patients had day 120 prescriptions that were unchanged from their initial prescription.

Conclusions: In the largest analysis of incident APD prescriptions conducted in the United States to date, most patients were prescribed nocturnal PD only with limited variability across the first 4 months of therapy.

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Conflict of interest statement

M.S. Anger reports Ownership Interest: Pfizer; Research Funding: Fresenius; and Advisory or Leadership Role: Fresenius. M.S. Anger, D.K. Chatoth, L.H. Ficociello, M. Kraus, R. Lasky, C. Mullon, and V. Parameswaran were Fresenius Medical Care employees at the time of this study. M.S. Anger, L.H. Ficociello, and C. Mullon have ownership interest in Fresenius Medical Care. D.K. Chatoth reports Ownership Interest: Amgen (stock owned by spouse); Advisory or Leadership Role: Fresenius Medical Care: Employed as Associate Chief Medical Officer; and Other Interests or Relationships: Kidney Care Partners and PDOPPS (member of US Steering Committee). H.E. Giles is a Consultant with Fresenius, JV partner with Davita with a dialysis unit, JV partner with Fresenius with dialysis units, and Medical Director of FKC Birmingham Home. H.E. Giles reports Employer: Nephrology Associates, PC; Ownership Interest: JV, Fresenius with dialysis units; Advisory or Leadership Role: Board Member, RPA and Fresenius and NxStage, Science Advisory Board member; Speakers Bureau: Renal Therapies Group, Fresenius; and Other Interests or Relationships: Personal minor investor in Evergreen Nephrology (value based care company), partner in author’s medical practice, Nephrology Associates, PC, we are in a collaborative care agreement with Evergreen Nephrology. M. Kraus reports Advisory or Leadership Role: Associate Chief Medical Officer—Fresenius Kidney Care, working in this capacity with SAB and MAB's. V. Parameswaran reports Employer: AstraZeneca and Kiniksa Pharmaceuticals; and Ownership Interest: Apple Inc., AstraZeneca, Intel, and Kiniksa Pharmaceuticals.

Figures

None
Graphical abstract
Figure 1
Figure 1
Day 120 nighttime prescriptions examined as categorical variables.
Figure 2
Figure 2
Changes in nighttime prescriptions from day 1 to day 120.
See this image and copyright information in PMC

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