Pongpratch Puapatanakul1,2,3, Talerngsak Kanjanabuch1,2,3,4, Kriang Tungsanga1, Areewan Cheawchanwattana5, Kittisak Tangjittrong6, Niwat Lounseng7, Phichit Songviriyavithaya8, Junhui Zhao9, Angela Yee-Moon Wang10, Jenny Shen11, Jeffrey Perl12, Simon J Davies13, Fredric O Finkelstein14, David W Johnson15,16,17. 1. Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 2. Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 3. Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. 4. Dialysis Policy and Practice Program (DiP3), School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 5. Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand. 6. Division of Nephrology, Department of Internal Medicine, Pranangklao Hospital, Nonthaburi, Thailand. 7. Department of Medicine, Trang Hospital, Thailand. 8. Division of Nephrology, Department of Medicine, Amnat Charoen Hospital, Thailand. 9. Arbor Research Collaborative for Health, Ann Arbor, MI, USA. 10. Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China. 11. Division of Nephrology and Hypertension, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA. 12. St. Michael's Hospital, Toronto, Ontario, Canada. 13. Faculty of Medicine and Health Sciences, Keele University, UK. 14. Department of Medicine, Yale University, New Haven, CT, USA. 15. Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia. 16. Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia. 17. Translational Research Institute, Brisbane, Queensland, Australia.
Abstract
BACKGROUND: Although caregivers allow peritoneal dialysis (PD) patients with disabilities the opportunity to perform PD, it is crucial to clarify the safety and effectiveness of assisted PD performed by caregivers compared to self-PD. METHODS: PD patients from 22 PD centres in Thailand were prospectively followed in the Peritoneal Dialysis Outcomes and Practice Patterns Study during 2016-2017. Patients receiving assisted PD performed by caregivers were matched 1:1 with self-PD patients using propensity scores calculated by logistic regression. The associations between assisted PD and risk of mortality, peritonitis and permanent transfer to haemodialysis (HD) were assessed by multivariable competing risk regression. RESULTS: Of 778 eligible patients, 447 (57%) required assisted PD performed by caregivers. Most of the caregivers were family members (98%), while the rest were non-family paid caregivers (2%). Patient factors associated with assisted PD were older age, female gender, lower educational level, cardiovascular comorbidities, diabetes, automated PD modality, poorer functional status and lower blood chemistries (albumin, creatinine, sodium, potassium and phosphate). After 1:1 matching, the baseline characteristics were adequately matched, and 269 patients in each group were analysed. Compared with self-PD, assisted PD was significantly associated with an increased risk of all-cause mortality (adjusted sub-hazard ratio: 2.15, 95% confidence interval: 1.24-3.74). There were no differences in the occurrences of peritonitis and permanent HD transfer between the groups. CONCLUSIONS: Assisted PD was required by more than half of Thai PD patients and was independently associated with a higher mortality risk. This may reflect causal effect or confounding by indication.
BACKGROUND: Although caregivers allow peritoneal dialysis (PD) patients with disabilities the opportunity to perform PD, it is crucial to clarify the safety and effectiveness of assisted PD performed by caregivers compared to self-PD. METHODS: PD patients from 22 PD centres in Thailand were prospectively followed in the Peritoneal Dialysis Outcomes and Practice Patterns Study during 2016-2017. Patients receiving assisted PD performed by caregivers were matched 1:1 with self-PD patients using propensity scores calculated by logistic regression. The associations between assisted PD and risk of mortality, peritonitis and permanent transfer to haemodialysis (HD) were assessed by multivariable competing risk regression. RESULTS: Of 778 eligible patients, 447 (57%) required assisted PD performed by caregivers. Most of the caregivers were family members (98%), while the rest were non-family paid caregivers (2%). Patient factors associated with assisted PD were older age, female gender, lower educational level, cardiovascular comorbidities, diabetes, automated PD modality, poorer functional status and lower blood chemistries (albumin, creatinine, sodium, potassium and phosphate). After 1:1 matching, the baseline characteristics were adequately matched, and 269 patients in each group were analysed. Compared with self-PD, assisted PD was significantly associated with an increased risk of all-cause mortality (adjusted sub-hazard ratio: 2.15, 95% confidence interval: 1.24-3.74). There were no differences in the occurrences of peritonitis and permanent HD transfer between the groups. CONCLUSIONS: Assisted PD was required by more than half of Thai PD patients and was independently associated with a higher mortality risk. This may reflect causal effect or confounding by indication.