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Promoting Peritoneal Dialysis Retention in Underserved Communities

Published:November 13, 2020DOI:https://doi.org/10.1016/j.amjms.2020.10.024
      Safety, autonomy, and quality of life for the patient are among the various merits of peritoneal dialysis (PD) extolled by clinical leaders, professional societies, and policymakers. As many as 85% of end-stage kidney disease (ESKD), excluding patients who may have difficulty performing PD (e.g., stroke, vision impairment, abdominal wounds), are medically eligible for PD.
      • Rivara M.B.
      • Mehrotra R.
      The changing landscape of home dialysis in the United States.
      However, PD remains a woefully underutilized modality in the United States, particularly in underserved communities. It is a credit to educational efforts and policy makers that increased awareness and provider incentives have resulted in a modest, but palpable increase in PD adoption in the last decade, now near 11% of incident patients.
      United States Renal Data System
      2019 USRDS Annual Data Report: Epidemiology of kidney disease in the United States.
      The ongoing challenge is the overall technique survival in the United States for PD, which is low, roughly 50% after three years.
      • Mujais S.
      • Story K.
      Peritoneal dialysis in the US: evaluation of outcomes in contemporary cohorts.
      ,
      • Shen J.I.
      • Mitani A.A.
      • Saxena A.B.
      • Goldstein B.A.
      • Winkelmayer W.C.
      Determinants of peritoneal dialysis technique failure in incident us patients.
      Improving technique retention should be a priority because it will impact prevalent rates of PD and can influence providers’ and patients’ perception about PD. The barriers to technique retention in large urban areas with diverse patient populations are particularly knotty and difficult to untangle. As Torres et al
      • Torres H
      • Nalijayan M
      • Frontini M
      • et al.
      Evaluating factors contributing to dropout in a large peritoneal dialysis program.
      have expertly illustrated, examining the reasons for technique failure is critical particularly in special populations because they have to reveal factors that may not be apparent and point to areas to focus further research and policy prescriptions.
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