Evaluating causes of dropout in a large peritoneal dialysis program
Location
Medical Education Building, LSUHSC-NO
Presentation Date
10-10-2019 10:00 AM
End Date
10-10-2019 12:00 PM
Description
Despite reduced healthcare costs and increased patient quality of life, Peritoneal dialysis (PD) sees relatively low prevalence (11-12%) vs. Hemodialysis (HD) (85-88%) in the U.S. The low prevalence rate of PD compared to HD is due to patient dropout from therapy. Dropout from PD is due to one of four factors: infection, inadequacy of dialysis, psychosocial factors, and mechanical failures. Our objective of was to determine the most prevalent cause for PD dropout in a patient population over the last 2 years. We completed a retrospective cohort study, identifying patients who withdrew from PD between 2016-2018 using the DaVita database, all patient data was deidentified. All patients admitted to the DaVita Memorial PD program were considered for this study. Dropout due to death, transfer to another clinic, or transplant were excluded as reasons for uncontrollable loss but were noted as a cause of dropout. We evaluated all other causes as controllable losses from PD. Patients were evaluated for time on therapy at dropout (very early, early and late) and method of initiation for PD (HD to PD conversion, urgent start PD, and conventional start). Of the 83 patients enrolled into our PD program from 2016-2018, 27 dropped out of the program. 24 were due to controllable factors, 3 due to death, and with a median age at dropout of 52 years old. We determined psychosocial factors to be the largest controllable factor influencing dropout; contributing a rate of 63% among all controllable factors. Psychosocial factors were stratified due to mental illness, loss of a support network, or inability to tolerate the volume of treatment sessions required by PD. Overall, the mean interval time to dropout of dialysis was 23 months (S.D. = 5) with median of 16 months. We found mean dropout time for psychosocial risk factors to be 13 months, other medical 26 and infections to be 33 months. Regarding time on therapy, 100% of very early dropout patients and 50% of late dropout patients did so due to psychosocial factors. Among early dropout patients 67% dropped out due to other medical reasons. Regarding type of initiation, we found psychosocial factors to be the largest attributable cause with 50% of unplanned,100% of planned, and 50% of conversions stopping therapy. Our study indicates that in our patient cohort, the primary reason for controllable loss from therapy was secondary to psychosocial factors. This was the case regardless of the time on therapy or the method of initiation to therapy. Future directions for our study will include developing an assessment tool to have an objective measurement for risk of dropout based on psychosocial factors.
Recommended Citation
Torres, Hayden; Naljayan, Mihran V.; Reisin, Efrain; and Erwin, Aguilar, "Evaluating causes of dropout in a large peritoneal dialysis program" (2019). Medical Student Research Poster Symposium. 41.
https://digitalscholar.lsuhsc.edu/sommrd/2019/posters/41
Evaluating causes of dropout in a large peritoneal dialysis program
Medical Education Building, LSUHSC-NO
Despite reduced healthcare costs and increased patient quality of life, Peritoneal dialysis (PD) sees relatively low prevalence (11-12%) vs. Hemodialysis (HD) (85-88%) in the U.S. The low prevalence rate of PD compared to HD is due to patient dropout from therapy. Dropout from PD is due to one of four factors: infection, inadequacy of dialysis, psychosocial factors, and mechanical failures. Our objective of was to determine the most prevalent cause for PD dropout in a patient population over the last 2 years. We completed a retrospective cohort study, identifying patients who withdrew from PD between 2016-2018 using the DaVita database, all patient data was deidentified. All patients admitted to the DaVita Memorial PD program were considered for this study. Dropout due to death, transfer to another clinic, or transplant were excluded as reasons for uncontrollable loss but were noted as a cause of dropout. We evaluated all other causes as controllable losses from PD. Patients were evaluated for time on therapy at dropout (very early, early and late) and method of initiation for PD (HD to PD conversion, urgent start PD, and conventional start). Of the 83 patients enrolled into our PD program from 2016-2018, 27 dropped out of the program. 24 were due to controllable factors, 3 due to death, and with a median age at dropout of 52 years old. We determined psychosocial factors to be the largest controllable factor influencing dropout; contributing a rate of 63% among all controllable factors. Psychosocial factors were stratified due to mental illness, loss of a support network, or inability to tolerate the volume of treatment sessions required by PD. Overall, the mean interval time to dropout of dialysis was 23 months (S.D. = 5) with median of 16 months. We found mean dropout time for psychosocial risk factors to be 13 months, other medical 26 and infections to be 33 months. Regarding time on therapy, 100% of very early dropout patients and 50% of late dropout patients did so due to psychosocial factors. Among early dropout patients 67% dropped out due to other medical reasons. Regarding type of initiation, we found psychosocial factors to be the largest attributable cause with 50% of unplanned,100% of planned, and 50% of conversions stopping therapy. Our study indicates that in our patient cohort, the primary reason for controllable loss from therapy was secondary to psychosocial factors. This was the case regardless of the time on therapy or the method of initiation to therapy. Future directions for our study will include developing an assessment tool to have an objective measurement for risk of dropout based on psychosocial factors.