Skip to main content

Research Repository

Advanced Search

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

Boyer, Annabel; Solis-Trapala, Ivonne; Tabinor, Matthew; Lambie, Mark; Davies, Simon


Annabel Boyer

Matthew Tabinor


<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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).</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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)].</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p> </jats:sec>

Journal Article Type Article
Acceptance Date Nov 26, 2019
Online Publication Date Mar 17, 2020
Publication Date 2020-09
Journal Nephrology Dialysis Transplantation
Print ISSN 0931-0509
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 35
Issue 9
Pages 1595-1601
Keywords assisted peritoneal dialysis, chronic kidney disease, peritoneal dialysis, renal replacement therapy, peritoneal dialysis, kidney failure, chronic, renal replacement therapy, mortality, transplantation, older adult, cox proportional hazards models
Publisher URL