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5 Efforts to Increase Patient Access to Peritoneal Dialysis

Appropriate patients treated with peritoneal dialysis (PD) have the potential to achieve lower rates of hospitalization and mortality, higher quality of life and lower costs than patients treated with in-center hemodialysis (ICHD). Unfortunately, the number of patients choosing PD has been essentially flat industry-wide over the last several years, related to a shortage of PD dialysate. Now, the shortage is over, and multiple dialysate supply vendors are available, which reduces the risk of future dialysis component shortages. This change sets the stage for a return to the pre-shortage growth in PD.

Education and outreach can help improve patient and physician perceptions of PD as a treatment option for end stage renal disease, and novel technologies can help facilitate comfort and success with PD. The following list details a multi-dimensional strategy that may help increase the number of patients on PD within a dialysis organization.

  1. Focus on the care team. Care team leaders can help create a PD-focused culture on the care team. Care team members should receive training on the potential benefits of PD and overall PD growth goals and consistently talk to patients about PD. PD growth can be tracked in real-time with a dashboard that shows key metrics related to PD growth.
  2. Prioritize multi-touch patient education. Electing home dialysis is an active choice on the part of a patient. Patients make more-informed decisions when they have access to programs that provide chronic kidney disease education and support during the first 90 to 120 days of dialysis. All nephrology practices should prioritize education for patients transitioning to dialysis.
  3. Engage and educate physicians and nurses. Communication tools can help raise awareness among physicians about their PD performance. Internal meetings and external sponsored events can expand physicians’ and nurses’ PD knowledge base and skills.
  4. Increase new patient access to PD. Care teams can work in conjunction with nephrology practices and hospitals to develop urgent-start PD programs. Data tools and educational programs regarding the potential benefits of PD should be developed for patients who have already initiated ICHD but are good candidates for PD.
  5. Retain patients on PD. Clinical analytic approaches can examine patient loss rates and identify opportunities to help with patient retention issues. Technological advances, such as home remote monitoring and internet-enabled PD cyclers, help improve patient and physician confidence and comfort in PD.

These are just a few efforts that may help encourage clinically appropriate patients to choose PD. Increasing the number of patients who are matched with the dialysis modality that best suits their needs could ultimately help improve clinical outcomes and patient quality of life.

Martin Schreiber, MD

Martin Schreiber, MD

With nearly 40 years of experience in nephrology, Martin Schreiber, MD, serves as chief medical officer for DaVita Kidney Care's home modalities. Before this role, he worked primarily with Cleveland Clinic and held a number of key positions there, including member of the Board of Governors, chairman of the Department of Nephrology and Hypertension and director of home dialysis.