Annabel Boyer1,2, Ivonne Solis-Trapala1, Matthew Tabinor1,3, Simon J Davies1,3, Mark Lambie1,3. 1. Faculty of Medicine and Health Sciences, Keele University, Stoke-on-Trent, UK. 2. Université de Caen Normandie-UFR de Médecine (Medical School), U1086 INSERM, Caen Cedex 5, France. 3. Renal Unit, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.
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.
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.
Authors: Maatla Tshimologo; Kerry Allen; David Coyle; Sarah Damery; Lisa Dikomitis; James Fotheringham; Harry Hill; Mark Lambie; Louise Phillips-Darby; Ivonne Solis-Trapala; Iestyn Williams; Simon J Davies Journal: BMJ Open Date: 2022-06-08 Impact factor: 3.006