Hemodialysis and peritoneal dialysis: patients' assessment of their satisfaction with therapy and the impact of the therapy on their lives.

This study was undertaken to examine patient satisfaction with peritoneal dialysis (PD) and hemodialysis (HD) therapies, focusing attention on the positive and negative impact of the therapies on patients' lives. Patients were recruited from a free-standing PD unit and two free-standing HD units. A total of 94% (n = 62) of eligible PD and 84% (n = 84) of eligible HD patients participated. HD patients were significantly older and had higher Charlson Comorbidity Index scores than the PD patients, but there were no differences in duration of dialysis treatment, prevalence of diabetes, educational backgrounds, or home situations. Patients were asked to rate their overall satisfaction with and the overall impact of their dialysis therapy on their lives, using a 1 to 10 Likert scale. In addition, patients were asked to rate the impact of their therapy on 15 domains that had been cited previously as being important for patients' quality of life. The mean satisfaction score for PD patients (8.02 +/- 1.41) was higher than for HD patients (7.4 +/- 1.4; P = 0.15). PD patients indicated that there was less impact of the dialysis treatment on their lives globally (7.25 +/- 2.12 versus 6.19 +/- 2.83; P = 0.019). In addition, PD patients noted less impact of the therapy in 14 of the 15 domains examined. With the use of a proportional odds model analysis, the only significant predictor of overall satisfaction and impact of therapy was dialysis modality (P = 0.037 and P = 0.021, respectively). Patients also were asked to comment freely on the positive and negative effects of the dialysis treatments on their lives, and a taxonomy of patient perceptions and concerns was developed. This study suggests that PD patients in general are more satisfied with their overall care and believe that their treatment has less impact on their lives than HD patients.

Compliance with the dialysis regimen in chronic peritoneal dialysis patients: utility of the pro card and impact of patient education.

Noncompliance (NC) with the dialysis prescription has been described as a common problem in dialysis patients. In previous studies, NC in peritoneal dialysis (PD) patients has been assessed by obtaining patient or family histories, using questionnaires, and making home visits. With the use of the HomeChoice Pro Chip Card (PCC: Baxter Healthcare Corporation, Deerfield, IL, U.S.A.), the dialysis staff can monitor the total volume of dialysate used, the frequency of exchanges, and the duration of dialysis in patients maintained on automated peritoneal dialysis (APD). Last year, we reported that the PCC was an effective tool for assessing compliance and noted that more than half of patients had a compliance rate (CR) < 95%. In the present study, we examined the impact of patient education on compliance with the prescribed dialysis regimen. We evaluated our APD patients for CR with their dialysis prescription. The PCC was used to record the duration of dialysis and the actual volume of fluid used. From October 2002 to September 2003, all patients maintained at home for 3 consecutive months on APD in the New Haven continuous ambulatory peritoneal dialysis unit were educated concerning the importance of compliance with their dialysis regimen. They were also educated about the function of the PCC and were informed that the dialysis facility would be monitoring their compliance with the prescribed regimen. Compliance rates were calculated by dividing the delivered dialysis volume by the prescribed dialysis volume and multiplying by 100. We obtained data on 42 APD patients. Of the 42 patients, 35 (83%) had a CR > or = 95%, 3 (7%) had a CR between 90% and 94.9%, and 4 (10%) had a CR < 90%. Those CRs are much better than the ones we had previously reported, before the institution of the patient education program. The PCC can be used to assess compliance in APD patients. Patient education results in an improvement in patient compliance. Further study is required to determine factors that affect CR in APD patients.

Comparison of quality-of-life assessment in Russia and the United States in chronic peritoneal dialysis patients.

Numerous reports of quality-of-life data in chronic peritoneal dialysis (CPD) patients in the United States and Western Europe use the short form questionnaire (SF-36). Few centers in Europe have reported data examining the incidence of depression in CPD patients. Depression has been shown to correlate with morbidity and mortality in dialysis patients. A high incidence of clinical depression is seen in end-stage renal disease patients in the United States. We thought it could be important to compare depression measurements between the United States and European countries. Quality-of-life data of the peritoneal dialysis patients from the New Haven continuous ambulatory peritoneal dialysis (CAPD) unit and from the New Technology Center at Hospital #31 in St. Petersburg were compared. The Beck Depression Inventory (BDI) and the SF-36, which includes the mental component score (MCS) and the physical component score (PCS), were administered to the patients. The study participants included 147 Russian and 96 U.S. patients. The BDI, PCS, and MCS scores were similar in both groups. The BDI scores in the Russian patients indicated that a high incidence of clinical depression likely exists in that patient population. The utility of the BDI in assessing quality-of-life issues in Europe and Russia requires further evaluation.

Racial differences and peritonitis in an urban peritoneal dialysis center.

Racial differences have been reported among various groups with end-stage renal disease maintained on dialysis. In particular, patient survival on dialysis has been reported to be better in African-American patients than in Caucasian patients. Peritonitis rates and dropout from chronic peritoneal dialysis (CPD) have been reported to be higher in African-American patients. We decided to review our experience with peritonitis rates in African-American and Caucasian patients. From 1994 to 2000, 403 patients were maintained on CPD in the New Haven continuous ambulatory peritoneal dialysis (CAPD) unit. Peritonitis rates were 1 episode in 14 patient-months in Caucasian patients and 1 episode in 13.6 patient-months in African-American patients. Mean ages at the start of dialysis were 52.4 +/- 16.2 years in the Caucasian patients and 62.6 +/- 14.9 years in the African-American patients. African-American patients were older. African-American and Caucasian patients had similar peritonitis rates. Time of first episode of peritonitis was not different in the two groups.

Increasing the dialysis volume and frequency in a fixed period of time in CPD patients: the effect on Kpt/V and creatinine clearance.

BACKGROUND: The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) has evidence- and opinion-based recommendations for weekly Kt/V(urea) and weekly total creatinine clearance (CC) in chronic peritoneal dialysis (CPD) patients. Using standard continuous ambulatory peritoneal dialysis technique, it is often difficult to achieve the suggested targets in anuric patients with large body mass. Thus, the use of automated peritoneal dialysis (APD) has been increasingly utilized to achieve adequate clearances. Automated dialysis is usually performed at night over an 8- to 10-hour period. The role of increases in dialysate volume and frequency of exchanges during this time period to achieve these target K/DOQI recommendations remains uncertain. We decided to study the effects of increasing the volume and number of exchanges in a fixed period of time in CPD patients. METHODS: In the New Haven CAPD unit, 29 patients maintained on APD were considered eligible for the study and 11 agreed to participate. The patients were characterized according to standard peritoneal equilibration test criteria. The patients were placed into two groups: group 1 included high (H) and high-average (HA), and group 2 low-average (LA) transporters. The patients were dialyzed at night for 9 hours with standard cycling technique, using 2.5% Dianeal (Baxter Healthcare, Deerfield, Illinois, USA) solution, with a cycle volume of 2,500 mL, and a 2,000-mL daytime dwell. Three studies were done on each patient using a total dialysis volume of 9.5 L (3 cycles), 14.5 L (5 cycles), and 19.5 L (7 cycles). Daily Kpt/V(urea) and daily CCp (peritoneal) (L/day/1.73 m2) were obtained. RESULTS: Six patients were H or HA (group 1) and 5 were LA transporters (group 2). For the group 1 patients, mean weight was 86.6 +/- 13.5 kg; Kpt/V(urea) was 1.68 +/- 0.21 using 9.5 L, 2.03 +/- 0.28 for 14.5 L (p < 0.05 compared to 10 L), and 2.28 +/- 0.28 with 19.5 L (p < 0.05 compared to 10 L and 15 L); mean weekly CCp was 45.43 +/- 7.63 L/1.73 m2 for 9.5 L (p < 0.05 compared to 14.5 L and 19.5 L), 51.17 +/- 7.07 with 14.5 L, and 54.67 +/- 10.08 for 19.5 L; ultrafiltration rates were not different in the three studies. For the group 2 patients, mean weight was 74.3 +/- 17.7 kg; mean weekly Kpt/V(urea) was 1.68 +/- 0.35 using 9.5 L, 2.10 +/- 0.42 for 14.5 L (p < 0.05 compared to 9.5 L), and 2.31 +/- 0.56 for 19.5 L (p < 0.05 compared to 9.5 L and 14.5 L); mean weekly CCp was 42.56 +/- 10.64 L/1.73 m2 for 9.5 L (p < 0.05 compared to 14.5 L and 19.5 L), 50.89 +/- 12.66 for 14.5 L, and 51.94 +/- 11.20 for 19.5 L; ultrafiltration was lower in the 9.5-L study than in the 14.5-L and 19.5-L studies, but was not different in the 14.5-L and 19.5-L studies. CONCLUSIONS: In both H/HA and LA transporters, Kpt/V(urea) and CCp rise significantly when the frequency of exchanges and total volume of dialysate are increased. Thus, the use of larger volumes of dialysate with cycling peritoneal dialysis may result in increased clearances of urea and creatinine.