Effect of social deprivation on peritoneal dialysis uptake: A mediation analysis with the data of the REIN registry

Background: Social deprivation could act as a barrier to peritoneal dialysis (PD). The objective of this study was to assess the association between social deprivation estimated by the European deprivation index (EDI) and PD uptake and to explore the potential mediators of this association. Methods: From the Renal Epidemiology and Information Network registry, patients who started dialysis in 2017 were included. The EDI was calculated based on the patient’s address. The event of interest was the proportion of PD 3 months after dialysis initiation. A mediation analysis with a counterfactual approach was carried out to evaluate the direct and indirect effect of the EDI on the proportion of PD. Results: Among the 9588 patients included, 1116 patients were on PD; 2894 (30.2%) patients belonged to the most deprived quintile (Q5). PD was associated with age >70 years (odds ratio (OR) 0.79 [95% confidence interval (CI): 0.69–0.91]), male gender (0.85 [95% CI: 0.74–0.97]), cardiovascular disease (OR 0.86 [95% CI: 0.86–1.00]), chronic heart failure (OR 1.34 [95% CI: 1.13–1.58]), active cancer (OR 0.67 [95% CI: 0.53–0.85]) and obesity (OR 0.75 [95% CI: 0.63–0.89]). In the mediation analysis, Q5 had a direct effect on PD proportion OR 0.84 [95% CI: 0.73–0.96]. The effect of Q5 on the proportion of PD was mediated by haemoglobin level at dialysis initiation (OR 0.96 [95% CI: 0.94–0.98]) and emergency start (OR 0.98 [95% CI: 0.96–0.99]). Conclusion: Social deprivation, estimated by the EDI, was associated with a lower PD uptake. The effect of social deprivation was mediated by haemoglobin level, a proxy of predialysis care and emergency start.

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Effect of social deprivation on peritoneal dialysis uptake. A mediation analysis with the data of the REIN Registry

Néphrologie & Thérapeutique ◽

10.1016/j.nephro.2021.07.282 ◽

2021 ◽

Vol 17 (5) ◽

pp. 273-274

Author(s):

M. Beaumier

Keyword(s):

Peritoneal Dialysis ◽

Mediation Analysis ◽

Social Deprivation ◽

Rein Registry

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Are there gender disparities in vascular access at dialysis initiation in France. A mediation analysis using the data of the REIN registry

Néphrologie & Thérapeutique ◽

10.1016/j.nephro.2021.07.270 ◽

2021 ◽

Vol 17 (5) ◽

pp. 268-269

Author(s):

M. Beaumier

Keyword(s):

Vascular Access ◽

Mediation Analysis ◽

Gender Disparities ◽

Dialysis Initiation ◽

Rein Registry

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Symptomatic SARS-CoV2 infections in patients treated in France by hemodialysis in an establishment, or at home or by peritoneal dialysis: Data from the REIN and RDPLF registry

Bulletin de la Dialyse à Domicile ◽

10.25796/bdd.v3i4.59643 ◽

2020 ◽

Vol 3 (4) ◽

pp. 213-226

Author(s):

Cécile Couchoud ◽

Christian Verger

Keyword(s):

Peritoneal Dialysis ◽

French Language ◽

Information Network ◽

Dialysis Unit ◽

Asymptomatic Patients ◽

Risk Of Mortality ◽

French Speaking ◽

Delay In Treatment ◽

Rein Registry ◽

At Home

In France all patients treated with dialysis are registered in the REIN registry (Epidemiology and Information Network in Nephrology) ; in addition the RDPLF (French Language Peritoneal Dialysis Registry) monitors patients treated at home in French-speaking regions and countries. Asymptomatic patients with a positive SARS-CoV2 test were excluded : the study focused only on patients with symptomatic COVID-19 disease. Data from REIN and RDPLF were used. In total, 3,541 patients were declared symptomatic with COVID-19. The proportion of patients with symptomatic SAR-coV2 infection was 4.9% in patients treated at home by peritoneal dialysis or hemodialysis and 8.0% in those treated in a dialysis unit. After adjustment for age and comorbidities, being treated at home was associated with a higher risk of mortality. In conclusion, home treatments could represent a solution for preventing the risk of contamination during the circulation of the virus. On the other hand, the risk of mortality in symptomatic patients at home could be linked to a delay in treatment: rigorous remote organization must be implemented so as not to delay the treatment of patients in the event of infection.

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Peritoneal Dialysis First: PD Should Be Considered for Dialysis Initiation

Nephrology Times ◽

10.1097/01.nep.0000352294.48155.93 ◽

2009 ◽

Vol 2 (5) ◽

pp. 6-7

Author(s):

J Kevin Tucker ◽

Bradley M. Denker

Keyword(s):

Peritoneal Dialysis ◽

Dialysis Initiation

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Sustained Increase in Peritoneal Dialysis Prevalence through a Structured PD Initiation Service

Peritoneal Dialysis International ◽

10.3747/pdi.2017.00261 ◽

2018 ◽

Vol 38 (5) ◽

pp. 374-376 ◽

Cited By ~ 1

Author(s):

Muhammad Masoom Javaid ◽

Behram Ali Khan ◽

Emily Xe Yeo ◽

Boon Wee Teo ◽

Srinivas Subramanian

Keyword(s):

Peritoneal Dialysis ◽

Rapid Expansion ◽

Dialysis Initiation ◽

Coordinated Care ◽

Timely Initiation ◽

Initiation Of Dialysis ◽

Patient Selection Criteria ◽

Dedicated Team ◽

Sustained Increase

A structured peritoneal dialysis (PD) initiation service provided by a dedicated team of nephrologists, interventionists, and PD nurses, taking patients through the stages of predialysis education and monitoring, dialysis catheter insertion, dialysis initiation, and follow-up in the immediate post-dialysis initiation period, can go a long way in expanding PD prevalence. The authors noticed a rapid expansion of their PD program following the introduction of such a service, and they share their experience in this article. A multidisciplinary team providing 1-stop coordinated care may help in alleviating the differences in patient selection criteria, minimize delays in PD catheter insertions, ensure timely initiation of dialysis, reduce the need to start dialysis urgently, actively identify and sort any teething issues, enhance patients’ confidence, and reduce technique failures.

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Molidustat for the treatment of renal anaemia in patients with dialysis-dependent chronic kidney disease: design and rationale of three phase III studies

BMJ Open ◽

10.1136/bmjopen-2018-026602 ◽

2019 ◽

Vol 9 (6) ◽

pp. e026602 ◽

Cited By ~ 5

Author(s):

Tadao Akizawa ◽

Megumi Taguchi ◽

Yoshimi Matsuda ◽

Kazuma Iekushi ◽

Takashi Yamada ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Peritoneal Dialysis ◽

Kidney Disease ◽

Haemoglobin Level ◽

Darbepoetin Alfa ◽

Treatment Duration ◽

Phase Iii ◽

Renal Anaemia ◽

Link Type ◽

Three Phase

IntroductionNew medications for anaemia associated with chronic kidney disease (CKD) are desirable, owing to the limitations of erythropoiesis-stimulating agents (ESAs), the current standard of care. Molidustat is a novel hypoxia-inducible factor prolyl-hydroxylase inhibitor that stimulates erythropoietin production, predominately in the kidney. We report methodological details of three phase III trials, named MolIdustat once dailY improves renal Anaemia By Inducing erythropoietin (MIYABI), designed primarily to investigate the efficacy of molidustat therapy in adults with renal anaemia and dialysis-dependent CKD.Methods and analysisMIYABI Haemodialysis-Correction (HD-C) is a single-arm trial (24-week treatment duration) in approximately 25 patients on haemodialysis, currently untreated with ESAs. MIYABI Peritoneal Dialysis (PD) is a single-arm trial (36 week treatment duration) in approximately 50 patients on peritoneal dialysis, treated or untreated with ESAs. MIYABI Haemodialysis-Maintenance (HD-M) is a randomised, active-controlled, double-blinded, double-dummy trial (52-week treatment duration) comparing molidustat with darbepoetin alfa in approximately 225 patients on haemodialysis, treated with ESAs. Molidustat (starting dose 75 mg/day) will be titrated 4-weekly to maintain haemoglobin in predetermined target ranges. The primary objective is to evaluate the efficacy of molidustat, using the following measures: the rate of rise in haemoglobin (g/L/week) at the first dose change up to week 8 (MIYABI HD-C); responder rate (MIYABI HD-C and MIYABI PD); mean haemoglobin level during weeks 33–36 and non-inferiority to darbepoetin alfa shown by change in mean haemoglobin level from baseline (MIYABI HD-M). The secondary objectives are to assess safety, pharmacokinetics and pharmacodynamics. These trials will provide the first evaluations of molidustat therapy in patients receiving either peritoneal dialysis or currently untreated with ESAs on haemodialysis, and provide further evidence in patients treated with ESAs on haemodialysis.Ethics and disseminationThe protocols were approved by ethics committees at all participating sites. The trials will be conducted in accordance with the Declaration of Helsinki and Good Clinical Practice. Results arising from these studies will be published in peer-reviewed journal(s).Trial registration numbersNCT03351166; Pre-results,NCT03418168; Pre-results,NCT03543657; Pre-results

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Rate of Decline of Residual Renal Function in Patients on Continuous Peritoneal Dialysis and Factors Affecting It

Peritoneal Dialysis International ◽

10.1177/089686080002000410 ◽

2000 ◽

Vol 20 (4) ◽

pp. 429-438 ◽

Cited By ~ 91

Author(s):

Manoj K. Singhal ◽

Shaunmukhum Bhaskaran ◽

Edward Vidgen ◽

Joanne M. Bargman ◽

Stephen I. Vas ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Renal Function ◽

Multivariate Analysis ◽

Peritoneal Dialysis ◽

Creatinine Clearance ◽

Outcome Measure ◽

Residual Renal Function ◽

Left Ventricular ◽

Male Gender

Objective We analyzed residual renal function (RRF) in a large number of new peritoneal dialysis (PD) patients to prospectively define the time course of decline of RRF and to evaluate the risk factors assumed to be associated with faster decline. Study Design Single-center, prospective cohort study. Setting Home PD unit of a tertiary care University Hospital. Patients The study included 242 patients starting continuous PD between January 1994 and December 1997, with a minimum follow-up of 6 months and at least three measurements of RRF. Measurement All patients had data on demographic and laboratory variables, episodes of peritonitis and the use of aminoglycoside (AG) antibiotics, temporary hemodialysis, and number of radiocontrast studies. Adequacy of PD was measured from 24-hour urine and dialysate collection and peritoneal equilibration test using standard methodology. Further data on RRF was collected every 3 to 4 months until the patient became anuric (urine volume < 100 mL/day or creatinine clearance < 1.0 mL/min) or until the end of study in December 1998. Outcome Measure The slope of the decline of residual glomerular filtration rate (GFR) (an average of renal urea and creatinine clearance) was the main outcome measure. Risk factors associated with faster decline were evaluated by a comparative analysis between patients in the highest and the lowest quartiles of the slopes of GFR, and a multivariate analysis using a stepwise option within linear regression and general linear models. Results There was a gradual deterioration of residual GFR with time on PD, with 40% of patients developing anuria at a mean of 20 months after the initiation of PD. On multivariate analysis, use of a larger volume of dialysate ( p = 0.0001), higher rate of peritonitis ( p = 0.0005), higher use of AG ( p = 0.0006), presence of diabetes mellitus ( p = 0.005), larger body mass index (BMI) ( p = 0.01), and no use of antihypertensive medications ( p = 0.04) independently predicted the steep slope of residual GFR. Male gender, higher grades of left ventricular dysfunction, and higher 24-hour proteinuria were associated with faster decline on univariate analysis only. Conclusion Faster decline of residual GFR corresponds with male gender, large BMI, presence of diabetes mellitus, higher grades of congestive heart failure, and higher 24-hour proteinuria. Higher rate of peritonitis and use of AG for the treatment of peritonitis is also associated independently with faster decline of residual GFR. Whether the type of PD (CAPD vs CCPD/NIPD) is associated with faster decline of residual GFR remains speculative.

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Timing of Peritoneal Dialysis Initiation and Mortality: Analysis of the Canadian Organ Replacement Registry

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2013.10.054 ◽

2014 ◽

Vol 63 (5) ◽

pp. 798-805 ◽

Cited By ~ 14

Author(s):

Arsh K. Jain ◽

Jessica M. Sontrop ◽

Jeffery Perl ◽

Peter G. Blake ◽

William F. Clark ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Dialysis Initiation ◽

Mortality Analysis ◽

Organ Replacement

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Patient Survival Between Hemodialysis and Peritoneal Dialysis Among End-Stage Renal Disease Patients Secondary to Myeloperoxidase-ANCA-Associated Vasculitis

Frontiers in Medicine ◽

10.3389/fmed.2021.775586 ◽

2022 ◽

Vol 8 ◽

Author(s):

Xueqin Wu ◽

Yong Zhong ◽

Ting Meng ◽

Joshua Daniel Ooi ◽

Peter J. Eggenhuizen ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Renal Disease ◽

End Stage Renal Disease ◽

Patient Survival ◽

Dialysis Initiation ◽

Dialysis Modality ◽

Significant Difference ◽

Stage Renal Disease ◽

End Stage

BackgroundA significant proportion of anti-neutrophil cytoplasmic antibody (ANCA) associated glomerulonephritis eventually progresses to end-stage renal disease (ESRD) thus requiring long-term dialysis. There is no consensus about which dialysis modality is more recommended for those patients with associated vasculitis (AAV-ESRD). The primary objective of this study was to compare patient survival in patients with AAV-ESRD treated with hemodialysis (HD) or peritoneal dialysis (PD).MethodsThis double-center retrospective cohort study included dialysis-dependent patients who were treated with HD or PD. Clinical data were collected under standard format. The Birmingham vasculitis activity score (BVAS) was used to evaluate disease activity at diagnosis and organ damage was assessed using the vasculitis damage index (VDI) at dialysis initiation.ResultsIn total, 85 patients were included: 64 with hemodialysis and 21 with peritoneal dialysis. The patients with AAV-PD were much younger than the AAV-HD patients (48 vs. 62, P < 0.01) and more were female (76.2 vs. 51.6%, P = 0.05). The laboratory data were almost similar. The comorbidities, VDI score, and immuno-suppressive therapy at dialysis initiation were almost no statistical difference. Patient survival rates between HD and PD at 1 year were 65.3 vs. 90% (P = 0.062), 3 year were 59.6 vs. 90% (P < 0.001), and 5 years were 59.6 vs. 67.5% (P = 0.569). The overall survival was no significant difference between the two groups (P = 0.086) and the dialysis modality (HD or PD) was not shown to be an independent predictor for all-cause death (hazard ratio (HR) 0.73; 95% confidence interval (CI) 0.31–1.7; P = 0.473). Cardio-cerebrovascular events were the main cause of death among AAV-HD patients while infection in patients with AAV-PD.ConclusionThese results provide real-world data that the use of either hemodialysis or peritoneal dialysis modality does not affect patient survival for patients with AAV-ESRD who need long-term dialysis.

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