Protected: Outcome Analysis of the Outpatient Pathway for Advanced Kidney Disease (MaReA): Focus on Dependent Patients

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Silvio Di Stante

S. Di Stante1, F. Bari1, D. Colasuonno1, P. Cutrì1, G. D’Onofrio1, L. Lionte1, L. Lucarelli1, S. Mambelli1, A.P. Rinaldi1, S. Silvestrini1, V. Sirolli2, M. Signoracci1, M. Di Luca1

1 UOC Nefrologia e Dialisi, Ospedale Santa Croce – Fano, AST 1 Pesaro – Urbino
2 Clinica Nefrologica, Ospedale SS Annunziata – Chieti, Università G. d’Annunzio Chieti-Pescara

Corresponding author:
Silvio Di Stante
UOC Nefrologia e Dialisi, PO Santa Croce,
v.le Vittorio Veneto, 2,
61032 Fano (PU), Italia
Tel/Fax 0721 882368/823437
E-mail: silvio.distante@sanita.marche.it

 

Abstract

Introduction. Chronic Kidney Disease (CKD) represents a global health challenge. The Advanced Kidney Disease Outpatient Program (MaReA) is an organizational model that prepares patients for renal replacement therapy (RRT), promoting informed choice and timely initiation of treatment. Peritoneal dialysis (PD) is a home-based therapy that offers greater autonomy, but its applicability depends on several factors.
Objective. The purpose of this study is to analyze the outcomes of a MaReA program, with a specific focus on assessing suitability for PD, patient autonomy, and the role of the caregiver.
Materials and Methods. A retrospective analysis was conducted on a cohort of patients with CKD stage 5 enrolled in the MaReA program. The analysis focused on suitability for PD, the outcome of the program for eligible patients, the degree of autonomy achieved, and the availability and type of caregiver for dependent patients.
Results. The evaluation showed that 61.2% of patients were deemed eligible for PD. Among eligible patients who completed the program, a high rate of PD adoption was observed. For the proportion of dependent patients, the presence of a caregiver is essential.
Conclusions. The MaReA program is an effective tool for identifying candidates for PD and adequately preparing them. Caregivers play a critical role in accessing home care for a subpopulation of frail patients. It is necessary to develop support strategies and implement telemedicine and assisted peritoneal dialysis programs to expand access to PD.

Keywords: advanced chronic kidney disease, peritoneal dialysis, caregiver, assisted PD, telemedicine

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PD in Italy: the 5th GSDP-SIN Census 2014

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Giancarlo Marinangeli

Giancarlo Marinangeli1, Loris Neri2, Giusto Viglino3, Anna Rachele Rocca4, Alessandro Laudon5, Antonio Ragusa6, Gianfranca Cabiddu7. On behalf of Peritoneal Dialysis Study Group of Italian Society of Nephrology

1 Nefrologia e Dialisi, Ospedale Maria SS dello Splendore, Giulianova, Teramo, Italy.
2 Nefrologia e Dialisi, Ospedale San Lazzaro, Via Pierino Belli 26, Alba, Cuneo, Italy.
3 Nefrologia e Dialisi, Ospedale San Lazzaro, Via Pierino Belli 26, Alba, Cuneo, Italy.
4 Nefrologia e Dialisi, Policlinico Umberto I, Roma, Italy.
5 Nefrologia e Dialisi, Azienda Provinciale Servizi Sanitari, Trento, Italy.
6 Nefrologia e Dialisi, Ospedale San Vincenzo, Taormina, Italy.
7 Nefrologia e Dialisi, Azienda Ospedaliera Brotzu, Cagliari, Italy.

Autore Corrispondente:
Dott. Loris Neri
SOC Nefrologia e Dialisi
Ospedale San Lazzaro, Via Pierino Belli 26 – Alba (CN)
Telefono 0173-316579
Fax 0173-316574
E-mail: lorisneri1960@gmail.com

 

Abstract

OBJECTIVES

To know PD modalities and results in Italy.

METHODS

The Census was carried out by means of an on-line questionnaire in ALL the 225 non-pediatric public centers which PERFORMED PD in 2014. The results were compared with those of previous Censuses (2005:Cs-05; 2008:Cs-08; 2010:Cs-10; 2012:Cs-12).

RESULTS

Incidence. In 2014 PD was begun (first treatment for ESRD) by 1,652 pts (CAPD: 57.2%) and HD by 4,442 pts (%PD-incidence= Cs-14: 27,1%; Cs-12: 23.4%; Cs-10: 23.3%; Cs-08: 22.8%; Cs-05: 24.2%). For the first time Incremental PD does not increase (Cs-14: 27,5%; Cs-12: 28,8%; Cs-10: 22,8%; Cs-08: 18,3%; Cs-05: 11,9%).

Prevalence. At 31/12/2014 there were 4,480 patients on PD (CAPD: 46.9%) (%PD-prevalence= Cs-14: Cs-12: 17.1%; Cs-10: 16.6%; Cs-08: 16.7%; Cs-05:16.8%; p=NS), 24.3% of whom were on assisted PD (family members: 83.6%; paid caregivers: 11.5%; nurses: 1.1%; NH: 2.8%).

Out. In 2014 there was no change in the PD drop-out rate (32.0 ep/100yrs-pt) (death: 502; transplant: 329; switch to HD: 528 pts). The main reason for transferring to HD remained peritonitis (24.8%). Choice (9.3%) and impossibility to continue PD (15.2%) are increasing.

Peritonitis. The peritonitis rate (953 episodes) was 0.224 ep/yrs-pt. The incidence of new cases of EPS in 2013-14 (39 cases=0.444 ep/100yrs-pt) is decreasing (2011-12= 0.505; 2009-10= 0.529; 2004-08= 0.701 ep/100-yrs-pt).

Other results. Compared to 2012, in 2014 the number of Centers using 3.86% for PET increased (41.3%) (Cs-12: 30.8%; Cs-10: 15.6%; p<0.001), while the number carrying out home visits (59.6%) remained unchanged (56.3% in 2012, 59.4% in 2010). CONCLUSIONS

Cs-14 confirms the extensive use, stability and good results of PD in Italy. Incremental PD and assisted PD are unchanged, peritonitis are decreased and EPS remains a rare event. PET-3.86% is increasingly used.

Keywords: Peritoneal Dialysis, Technique failure, Incremental peritoneal dialysis, assisted PD, peritonitis, home visit, PET (peritoneal equilibration test)

Sorry, this entry is only available in Italiano.

INTRODUZIONE

L’utilizzo della dialisi peritoneale (PD) in Italia nel 2013 è risultato sostanzialmente stabile e limitato ad una incidenza del 13,2% ed una prevalenza inferiore al 9,6% (1) se si considerano tutti i Centri Dialisi, anche quelli che non utilizzano la metodica. Invariata anche la notevole variabilità da regione a regione e da centro a centro (2–5). L’utilizzo della DP viene rilevato dal Gruppo di Studio della DP (GSDP) della Società Italiana di Nefrologia (SIN) mediante un Censimento, condotto ogni 2 anni, di tutti i Centri che utilizzano la DP.

In questo report sono presentati i risultati della 5° edizione condotta nel 2016 e relativa all’anno 2014 (Cens-14) confrontandoli con quelli degli anni precedenti: 2005 (Cens-05), 2008 (Cens-08) (3), 2010 (4), 2012 (Cens-12) (5).

 

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PD in Italy: The 4th GSDP-SIN census 2012

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Giancarlo Marinangeli

Giancarlo Marinangeli1, Gianfranca Cabiddu2, Loris Neri3,
Giusto Viglino3, Roberto Corciulo4, Anna Rachele Rocca5,
Alessandro Laudon6, Viviana Finato7. A nome del Gruppo di Studio Dialisi Peritoneale della SIN

(1) Ospedale Maria SS dello Splendore, Giulianova
(2) Azienda Ospedaliera Brotzu, Cagliari
(3) Ospedale San Lazzaro, Alba
(4) Università di Bari, Bari
(5) Policlinico Umberto I, Roma
(6) Azienda Provinciale Servizi Sanitari, Trento
(7) Ospedale degli Infermi, San Miniato

AUTORE CORRISPONDENTE
Loris Neri
Ospedale San Lazzaro,
SOC Nefrologia, Dialisi e Nutrizione Clinica
Via Pierino Belli 26 – Alba (CN)
Telefono 0173-316579
Telefono 333-3935557
Fax 0173-316574
Email: lorisneri1960@gmail.com

 

Abstract

OBJECTIVES To know PD modalities and results in Italy.

METHODS The Census was carried out by means of an on-line questionnaire in all the 224 non-pediatric public centers which performed PD in 2012. The results were compared with those of previous Censuses.

RESULTS

Incidence. In 2012 PD was begun (first treatment for ESRD) by 1,433 pts (CAPD: 54.3%) and HD by 4,700 pts (%PD-incidence= Cs-12: 23.4%; Cs-10: 23.3%; Cs-08: 22.8%; Cs-05: 24.2%; p=NS), with a further increase in incremental PD (Cs-12: 28.8%; Cs-10: 22.8%; Cs-08: 18.3%; Cs-05: 11.9%; p<0.001).

Prevalence. At 31/12/12 there were 4,299 patients on PD (CAPD: 46.1%) (%PD-prevalence= Cs-12: 17.1%; Cs-10: 16.6%; Cs-08: 16.7%; Cs-05:16.8%; p=NS), 24.5% of whom were on assisted PD (family members: 82.3%; paid caregivers: 12.4%; nurses: 0.7%;  NH: 3.0%).

Out. In 2012 there was no change in the PD drop-out rate (30.9 ep/100yrs-pt) (death: 481; transplant: 290; switch to HD: 511 pts). The main reason for transferring to HD remained peritonitis (28.2%).

Peritonitis. The peritonitis rate (1,179 episodes) was 0.284 ep/yrs-pt.

EPS. The incidence of new cases of EPS in 2011-12 (43 cases=0.505 ep/100yrs-pt) remained unchanged (2009-10= 0.529; 2004-08= 0.701 ep/100-yrs-pt).

Other results. Compared to 2010, in 2012 the number of Centers using 3.86% for PET increased (30.8% vs 15.6%-p<0.001), while the number carrying out home visits remained unchanged (56.3 vs 59.4%).

CONCLUSIONS Cs-12 confirms the extensive use, stability and good results of PD in Italy. Incremental PD is on the increase. EPS remains a rare event.

Key words: Assisted Pd, Home Visit, Incremental Peritoneal Dialysis, Peritoneal Dialysis, Peritonitis, Technique Failure

Sorry, this entry is only available in Italiano.

INTRODUZIONE

L’utilizzo della dialisi peritoneale (DP) in Italia è risultato confinato, nel 2012, ad una incidenza del 12,8% ed una prevalenza del 9,8% (1) se si considerano tutti i Centri Dialisi, anche quelli che non utilizzano la metodica, ed è rimasta sostanzialmente stabile negli ultimi anni, sempre comunque con una notevole variabilità da regione a regione e da centro a centro (2). L’utilizzo della DP viene rilevato dal Gruppo di Studio della DP (GSDP) della Società Italiana di Nefrologia (SIN) mediante un Censimento, condotto ogni 2 anni, di tutti i Centri che utilizzano la DP.

In questo report sono presentati i risultati dell’edizione condotta nel 2013-14 e relativa all’anno 2012 (Cens-12), confrontati con quelli degli anni precedenti: 2005 (Cens-05) e 2008 (Cens-08) (3), 2010 (4) e con i dati internazionali.

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