Trends in Peritoneal Dialysis Technique Survival, Death, and Transfer to Hemodialysis: A Decade of Data from the RDPLF

2021 ◽  
pp. 1-10
Author(s):  
Annabel Boyer ◽  
Antoine Lanot ◽  
Mark Lambie ◽  
Christian Verger ◽  
Sonia Guillouet ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
French Language ◽  
Limited Information ◽  
Start Time ◽  
Calendar Time ◽  
Technique Survival ◽  
End Point ◽  
The Individual ◽  
Retrospective Multicenter Study ◽  
Over Time

<b><i>Introduction:</i></b> There is limited information on the trends of peritoneal dialysis (PD) technique survival over time. This study aimed to estimate the effect of calendar time on technique survival, transfer to hemodialysis (HD) (and the individual causes of transfer), and patient survival. <b><i>Methods:</i></b> This retrospective, multicenter study, based on data from the French Language Peritoneal Dialysis Registry, analyzed 14,673 patients who initiated PD in France between January 1, 2005, and December 31, 2016. Adjusted Cox regressions with robust variance were used to examine the probability of a composite end point of either death or transfer to HD, death, and transfer to HD, accounting for the nonlinear impact of PD start time. <b><i>Results:</i></b> There were 10,201 (69.5%) cases of PD cessation over the study period: 5,495 (37.4%) deaths and 4,706 (32.1%) transfers to HD. The rate of PD cessation due to death or transfer to HD decreased over time (PR 0.96, 95% CI: 0.95–0.97). Compared to 2009–2010, starting PD between 2005 and 2008 or 2011 and 2016 was strongly associated with a lower rate of transfer to HD (PR 0.88, 95% CI: 0.81–0.96, and PR 0.91, 95% CI: 0.84–0.99, respectively), mostly due to a decline in the rate of infection-related transfers to HD (PR 0.96, 95% CI: 0.94–0.98). <b><i>Conclusions:</i></b> Rates of the composite end point of either death or transfer to HD, death, and transfer to HD have decreased in recent decades. The decline in transfers to HD rates, observed since 2011, is mainly the result of a significant decline in infection-related transfers.

scholarly journals Trends in assisted peritoneal dialysis over the last decade: a cohort study from the French Peritoneal Dialysis Registry

2020 ◽  
Vol 13 (6) ◽  
pp. 1003-1011
Author(s):  
Annabel Boyer ◽  
Antoine Lanot ◽  
Mark Lambie ◽  
Sonia Guillouet ◽  
Thierry Lobbedez ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cox Regression ◽  
Prevalence Ratio ◽  
Economic Incentive ◽  
Economic Incentives ◽  
Limited Information ◽  
Calendar Time ◽  
The Impact ◽  
Assisted Peritoneal Dialysis ◽  
Over Time

Abstract Background There is limited information available on the use of assisted peritoneal dialysis (PD) over time and the impact of economic incentives on its utilization. The aim of this study was to describe the trends in assisted PD utilization and the type of assistance provided. We wanted to estimate if an economic incentive implemented in 2011 in France was associated with an increase in the utilization of nurse-assisted PD. Methods This retrospective, multicentre study, based on data from the French Language Peritoneal Dialysis Registry, analysed 11 987 patients who initiated PD in France between 1 January 2006 and 31 December 2015. Adjusted Cox regression with robust variance was used to examine the initiation of assisted PD, both nurse-assisted and family-assisted, accounting for the nonlinear impact of the PD starting time. Results There were 6149 (51%) incident patients on assisted PD, 5052 (82%) on nurse-assisted PD and 1097 (18%) on family-assisted PD over the study period. In the adjusted analysis, calendar time was associated with the assisted PD rate: it declined from 2008 until 2013 before flattening out and then it increased after 2014. Nurse-assisted PD utilization increased significantly after 2012, whereas family-assisted PD utilization decreased linearly over time (prevalence ratio = 0.94, 95% confidence interval 0.92–0.97). Conclusions The assisted PD rate decreased until 2013, mainly because of a decline in family-assisted PD. The uptake in nurse-assisted PD observed from 2013 reflects the effect of an economic incentive adopted in late 2011 to increase PD utilization.

Impact of Assisted Peritoneal Dialysis Modality on Outcomes: A Cohort Study of the French Language Peritoneal Dialysis Registry

2018 ◽  
Vol 48 (6) ◽  
pp. 425-433 ◽  
Author(s):  
Solène Guilloteau ◽  
Thierry Lobbedez ◽  
Sonia Guillouët ◽  
Christian Verger ◽  
Maxence Ficheux ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Lower Risk ◽  
Regression Models ◽  
Cox Regression ◽  
French Language ◽  
Dialysis Modality ◽  
Technique Survival ◽  
Hazard Ratios ◽  
Effect Of Pd ◽  
Assisted Peritoneal Dialysis

Background: Patients on peritoneal dialysis (PD) can be assisted by a nurse or a family member and treated either by automated PD (APD) or continuous ambulatory PD (CAPD). The aim of this study was to evaluate the effect of PD modality and type of assistance on the risk of transfer to haemodialysis (HD) and on the peritonitis risk in assisted PD patients. Method: This was a retrospective study based on data from the French Language PD Registry. All adults starting assisted PD in France between 2006 and 2015 were included. Events of interest were transfer to HD, peritonitis and death. Cox regression models were used for statistical analysis. Results: Among the 12,144 incident patients who started PD in France during the study period, 6,167 were assisted. There were 5,060 nurse-assisted and 1,095 family-assisted PD patients. Overall, 5,171 were treated by CAPD and 996 by APD. In multivariate analysis, CAPD, compared to APD, was not associated with the risk of transfer to HD (cause specific hazard ratios [cs-HR] 0.96 [95% CI 0.84–1.09]). Patients on nurse-assisted PD had a lower risk of transfer to HD than family assisted PD patients (cs-HR 0.85 [95% CI 0.75–0.97]). Neither PD modality nor type of assistance were associated with peritonitis risk. Conclusions: In assisted PD, technique survival was not associated with PD modality. Nurse-assisted patients had a lower risk of transfer to HD than family assisted patients. Peritonitis risk was not influenced either by PD modality, or by type of assistance. Both APD and CAPD should be offered to assisted-PD patients.

scholarly journals Estimation of the Center Effect on Early Peritoneal Dialysis Failure: A Multilevel Modelling Approach

2016 ◽  
Vol 36 (5) ◽  
pp. 519-525 ◽  
Author(s):  
Sonia Guillouët ◽  
Ghislaine Veniez ◽  
Christian Verger ◽  
Clémence Béchade ◽  
Maxence Ficheux ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Random Effect ◽  
Multilevel Modelling ◽  
French Language ◽  
Significant Heterogeneity ◽  
Individual Level ◽  
Center Effect ◽  
The Individual ◽  
Observation Period ◽  
Modelling Approach

IntroductionThis study was carried out to investigate the center effect on the risk of peritoneal dialysis (PD) failure within the first 6 months of therapy using a multilevel approach.MethodsThis was a retrospective cohort study based on data from the French Language Peritoneal Dialysis Registry. We analyzed 5,406 incident patients starting PD between January 2008 and December 2012 in 128 PD centers. The end of the observation period was December 31, 2013.ResultsOf the 5,406 patients, 415 stopped PD within the first 6 months. There was a significant heterogeneity between centers (variance of the random effect: 0.10). Only 3% of the variance of the event of interest was attributable to differences between centers. At the individual level, only treatment before PD (odds ratio [OR]: 1.93 for hemodialysis and OR: 2.29 for renal transplantation) and underlying nephropathy ( p < 0.01) were associated with early PD failure. At the center level, only center experience was associated (OR: 0.78) with the risk of PD failure. Center effect accounted for 52% of the disparities between centers.ConclusionCenter effect on early PD failure is significant. Center experience is associated with a lower risk of transfer to hemodialysis.

Clusters of Practice in Peritoneal Dialysis in France: Data from the Catheter Section of the RDPLF

2017 ◽  
Vol 38 (2) ◽  
pp. 89-97 ◽  
Author(s):  
Antoine Lanot ◽  
Clémence Bechade ◽  
Christian Verger ◽  
Emmanuel Fabre ◽  
Isabelle Vernier ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Outcomes ◽  
Prophylactic Antibiotic ◽  
French Language ◽  
Standards Of Care ◽  
Hierarchical Analysis ◽  
Exit Site ◽  
Adherence To Guidelines ◽  
International Guidelines ◽  
Retrospective Multicenter Study

Background Peritonitis is a major cause of peritoneal dialysis (PD) failure. Recommendations for the prevention of peritonitis are available, but wide variations exist in the peritonitis rate among countries and PD units. The objective of this study was to describe the different pattern of practices in France. Methods This was a retrospective, multicenter study based on data from the French Language Peritoneal Dialysis Registry. Center practices were described and mapped. Clusters of practices were sought in a hierarchical analysis and centers belonging to the same clusters of practices were mapped. Results Data from 2,770 catheters placed in 64 centers in France between 1 February 2012 and 31 December 2016 were considered. A median of 34 (ranging from 5 to 133) catheters was reported in each center. Twenty-eight (43.8%) centers routinely administered a prophylactic antibiotic prior to catheter placement, and 8 (12.5%) centers applied a local prophylactic antibiotic at the exit site, as recommended by International guidelines. The presence of a PD nurse specialized in PD or PD referent nephrologist was not associated with better adherence to guidelines. Practices were heterogeneous across centers. We identified 5 clusters of centers according to practice. Geographical proximity was not associated with homogeneity in practices. Conclusion Peritoneal dialysis practices are heterogeneous in France, even those that are subject to International guidelines. Studies to identify associations between center-specific practices and PD patient outcomes remain mandatory. Efforts should be made to standardize the PD standards of care in France.

Determination of Individual Ultrafiltration Time (Apex) and Purification Phosphate Time by Peritoneal Equilibration Test: Application to Individual Peritoneal Dialysis Modality Prescription in Children

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 557-561 ◽  
Author(s):  
Michel Fischbach ◽  
Ahmed Lahlou ◽  
Didier Eyer ◽  
Philippe Desprez ◽  
Jean Geisert
Keyword(s):  
Peritoneal Dialysis ◽  
Dwell Time ◽  
Wide Distribution ◽  
Individual Choice ◽  
Major Goal ◽  
Peritoneal Equilibration Test ◽  
Test Application ◽  
The Individual ◽  
Over Time ◽  
Solute Clearance

Efficiency of peritoneal dialysis (PD) is dependent on adequate ultrafiltration (UF) and purification (solute clearance). These two goals apparently seem to conflict in terms of duration of dwells: short dwell time enhances UF capacity and, conversely, long dwell time enhances solute clearance. Peritoneal equilibration test (PET) allows an approach to the ultrafiltration time: the point at which the over time dialysate urea saturation and glucose desaturation curves cross, called APEX time. PET also allows an approach to the purification time: the point at which dialysate-to-plasma (DIP) concentration ratios over time are high. Because of the value of phosphate as a uremic factor of morbidity, we have chosen the time at which DIP phosphate is equal to 0.6 as a purification phosphate dwell time (PPT). A total of 17 patients were studied, over a five-year period, allowing 142 determinations. APEX times (range 18 71 min) and PPT (range 105 -238 min) were spread over a wide distribution. PPT and APEX times were significantly shorter in children younger than three years of age than in children older than ten years of age. PPT were nearly four times longer than APEX times. Knowledge of these conflicting ultrafiltration and purification times should help, in our view, in the individual choice of the PD modality: if UF is the major goal, short dwell times should be used (automated PD); if purification is the major goal, long dwell times should be used, as in continuous ambulatory peritoneal dialysis; if both are the target goal, tidal PD should be discussed.

Peritoneal Dialysis in Brazil: Twenty-Five Years of Experience in a Single Center

2009 ◽  
Vol 29 (5) ◽  
pp. 492-498 ◽  
Author(s):  
Thyago P. Moraes ◽  
Roberto Pecoits–Filho ◽  
Silvia C. Ribeiro ◽  
Mariane Rigo ◽  
Margarete M. Silva ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Albumin Level ◽  
Serum Phosphate Level ◽  
Years Of Experience ◽  
Single Center ◽  
Technique Survival ◽  
Center Report ◽  
Risk Patients ◽  
Over Time ◽  
Low Serum

Objectives To evaluate patient and technique survival and to provide an analysis of peritoneal dialysis (PD)-related peritonitis in 25 years of experience in a single center. Study Design Retrospective study of incident patients on PD from July 1980 to July 2005. Setting Single, university based, Brazilian dialysis program. Patients 680 patients were analyzed in our study from July 1980 to July 2005, with a cumulative experience of 15303 patient-months. All patients over 15 years of age entering the dialysis program were included in the study. Patients with less than 30 days of follow-up were excluded. Biochemical and demographic variables, peritonitis episodes, and patient and technique survival were analyzed. Results Mean age at start of PD was 53 ± 16 years; diabetic nephropathy was the main cause of chronic kidney disease. Cardiovascular disease was the main cause of death (44%); peritonitis was responsible for 16% of fatal events. The predictors of death in our study were diabetes [relative risk (RR) 1.23, p < 0.01], advanced age (RR 1.58, p < 0.001), low serum albumin level (RR 1.25, p < 0.01), and low serum phosphate level (RR 1.39, p < 0.001) upon starting PD. There were 1048 cases of peritonitis over the 25-year period, with a significant reduction in incidence after the introduction of the double-bag system. The number of incident PD patients originating from hemodialysis increased threefold over the observation period ( p < 0.001), with a similar increase in comorbidities over time. Conclusion In the largest single-center report of PD experience in Latin America, we describe the overall rate and trends over time of peritonitis as well as patient and technique survival, which are similar to previous reports. Significant changes in peritonitis rates and causative organisms as well as a significant time-dependent increase in high-risk patients starting PD were observed.

scholarly journals Changes in Patient and Technique Survival over Time among Incident Peritoneal Dialysis Patients in Canada

2012 ◽  
Vol 7 (7) ◽  
pp. 1145-1154 ◽  
Author(s):  
Jeffrey Perl ◽  
Ron Wald ◽  
Joanne M. Bargman ◽  
Yingbo Na ◽  
S. Vanita Jassal ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Technique Survival ◽  
Over Time

scholarly journals Understanding Student Coregulation in Task Interpretation during Electronics Laboratory Activities

2016 ◽  
Vol 9 (7) ◽  
pp. 1
Author(s):  
Presentacion Rivera-Reyes ◽  
Oenardi Lawanto ◽  
Michael L. Pate
Keyword(s):  
Problem Solving ◽  
Laboratory Work ◽  
Limited Information ◽  
Self Regulated Learning ◽  
Laboratory Activities ◽  
Low Levels ◽  
The Individual ◽  
Task Interpretation ◽  
Over Time ◽  
And Task

<p class="apa">Coregulation (CRL) is a transitional process in which students share problem-solving techniques and utilize self-regulated learning (SRL) when interacting with peers. Coregulation may help students to define and modify inconsistencies in their SRL strategy. Task interpretation is described as the critical first step in the SRL process, and it is a key determinant in setting the goals and strategies to accomplish those goals. Limited information exists regarding coregulation and task interpretation in the context of laboratory work. Laboratory activities help students to move from abstract ideas to a practical understanding. However, it is generally agreed among educators that students involve little mental engagement in the laboratory activities. The purpose of this study was to investigate how students’ level of coregulation was associated with their task interpretation and how the level changed over time. One-hundred and forty-three sophomore students enrolled in an electronics course participated in this study. A paper-and-pencil questionnaire was used to measure students’ coregulation. Similarly, a questionnaire developed and piloted by the researcher measured students’ task interpretation. High-coregulated students showed high levels of SRL, while low-coregulated students showed low levels of SRL. The findings confirmed a previous study by Hadwin and Oshige, which described coregulation as a process in a learner’s acquisition of SRL, in which SRL is gradually appropriated by the individual learner’s interactions when they are working in the assigned task activities. Further investigation is necessary to unveil other factors related to these constructs in order to engage students in laboratory work.</p>

scholarly journals Impact of the implementation of an assisted peritoneal dialysis service on peritoneal dialysis initiation

2020 ◽  
Vol 35 (9) ◽  
pp. 1595-1601
Author(s):  
Annabel Boyer ◽  
Ivonne Solis-Trapala ◽  
Matthew Tabinor ◽  
Simon J Davies ◽  
Mark Lambie
Keyword(s):  
Peritoneal Dialysis ◽  
Cox Regression ◽  
Limited Information ◽  
Single Centre ◽  
Centre Study ◽  
Renal Replacement Therapies ◽  
Single Centre Study ◽  
The Impact ◽  
Assisted Peritoneal Dialysis ◽  
Over Time

Abstract Background There is limited information available on the impact that provision of an assisted peritoneal dialysis (PD) service has on the initiation of PD. The aim of this study was to assess this impact in a centre following initiation of assisted PD in 2011. Methods This retrospective, single-centre study analysed 1576 patients incident to renal replacement therapies (RRTs) between January 2002 and 2017. Adjusted Cox regression with a time-varying explanatory variable and a Fine and Gray model were used to examine the effect of assisted PD use on the rates and cumulative incidence of PD initiation, accounting for the non-linear impact of RRT starting time and the competing risks (transplant and death). Results Patients starting PD with assistance were older than those starting unassisted: median (interquartile range): 70.0 (61.5–78.3) versus 58.7 (43.8–69.2) years old, respectively. In the adjusted analysis assisted PD service availability was associated with an increased rate of PD initiation [cause-specific hazard ratio (cs-HR) 1.78, 95% confidence interval 1.21–2.61]. During the study period, the rate of starting PD fell before flattening out. Transplantation and death rates increased over time but this did not affect the fall in PD initiation [for each year in the study cs-HR of starting PD 0.95 (0.93–0.98), sub-distribution HR 0.95 (0.94–0.97)]. Conclusions In a single-centre study, introducing an assisted PD service significantly increased the rate of PD initiation, benefitting older patients most. This offsets a fall in PD usage over time, which was not explained by changes in transplantation or death.

Efficacy of Prophylactic Antibiotics at Peritoneal Catheter Insertion on Early Peritonitis: Data from the Catheter Section of the French Language Peritoneal Dialysis Registry

2016 ◽  
Vol 44 (6) ◽  
pp. 419-425 ◽  
Author(s):  
Antoine Lanot ◽  
Thierry Lobbedez ◽  
Clémence Bechade ◽  
Christian Verger ◽  
Emmanuel Fabre ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Beneficial Effect ◽  
Lower Risk ◽  
Random Effect ◽  
Prophylactic Antibiotic ◽  
Prophylactic Antibiotics ◽  
Catheter Placement ◽  
French Language ◽  
Peritoneal Catheter ◽  
The Individual

Background: International guidelines recommend the use of a prophylactic antibiotic before the peritoneal dialysis (PD) catheter can be inserted. The main objective of this study was to assess whether this practice is associated with a lower risk of early peritonitis and to estimate the magnitude of the centre effect. Methods: A retrospective, multi-centric study was conducted, in which data from the French Language Peritoneal Dialysis Registry was analysed. Patients were separated into 2 groups based on whether or not prophylactic antibiotics were used prior to catheter placement. Results: Out of the 2,014 patients who had a PD catheter placed between February 1, 2012 and December 31, 2014, 1,105 were given a prophylactic antibiotic. In a classical logit model, the use of prophylactic antibiotics was found to protect the individual against the risk of early peritonitis (OR 0.67, 95% CI 0.49-0.92). However, this association lost significance in a mixed logistic regression model with centre as a random effect: OR 0.73 (95% CI 0.48-1.09). Covariates associated with the risk of developing early peritonitis were age over 65: OR 0.73 (95% CI 0.39-0.85), body mass index over 35 kg/m2: OR 1.99 (95% CI 1.13-3.47), transfer to PD due to graft failure: OR 2.24 (95% CI 1.22-4.11), assisted PD: OR 1.96 (95% CI 1.31-2.93), and the use of the Moncrief technique: OR 3.07 (95% CI 1.85-5.11). Conclusion: There is a beneficial effect of prophylactic antibiotic used prior to peritoneal catheter placement, on the occurence of early peritonitis. However, the beneficial effect could be masked by a centre effect.

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