Empower your patients’ independence through PD1–4
Dialysis therapy is a long journey. PD allows your patients the freedom to stay at home longer.
PD and kidney transplant
A kidney transplant is the goal for many end-stage renal disease (ESRD) patients but may not always be an option at the start of their renal replacement therapy.
Patients treated with PD before kidney transplantation had improved patient survival and similar graft survival compared with those treated with in-center HD.8
Why not help reduce mortality rates?
Adjusted mortality by treatment modality and number of months after treatment initiation among ESRD patients (2013)9
USRDS: United States Renal Data System
Data collection from the 2016 USRDS Annual Data Report, vol. 2. Adjusted (age, race, sex, ethnicity, and primary diagnosis) mortality among incident ESRD patients in 2013 during the first year of therapy. Patients were followed from ESRD onset (Day 1; as reflected by first service date) up to one year. Data was removed for patients who missed follow-up appointments, received a transplant, or recovered kidney function for more than 90 days. The analyses were conducted separately for dialysis patients under the age of 65 and aged 65 and over.
RRF in patients receiving PD compared to HD using standard quality dialysis fluid10
- PD patients averaged a 30% (SE 8%) higher rGFR than HD patients (p <.0001) over a 12-month period10
- PD patients experienced a slower rate of rGFR decline than HD patients10
RRF: residual renal function; rGFR: reference glomerular filtration rate
Adapted from Jansen M, et al. The study analyzed the decline rates of rGFR prospectively in 522 incident HD and PD patients who had scheduled follow-up assessments. GFR was measured as the mean urea and creatinine clearance, calculated from urine collections. The initial value was obtained between 0 and 4 weeks before the start of dialysis. The measurements were repeated 3, 6, and 12 months after the start of dialysis treatment.
After adjustment for baseline variables and dropout, averaged over time, PD patients averaged 30% higher rGFR than HD patients over a 12-month period (p<.0001)10
Therapeutic benefits of preserving RRF are numerous
- Fluid removal11
- Sodium removal11,12
- Phosphate removal11,12
- Middle molecule clearance11,12
- Erythropoietin production11
- Reduced left ventricular hypertrophy11,12
- Survival benefit11
Why preserving residual renal function is key
Residual Renal Function (RRF) is better preserved in patients treated with PD compared to those treated with HD:10
- PD patients averaged a 30% (SE 8%) higher rGFR than HD patients (p<.0001) over a 12-month period.10
- PD patients experienced a slower rate of rGFR decline than HD patients.10
Preservation of RRF is associated with patient survival13
- Each 250 mL increase in daily urine volume was associated with a 36% lower relative risk of death.14
- A residual GFR increase of 1 mL/min/1.73 m2 resulted in a 12% reduction in relative risk of death.15
Why PD is preferred by prescribers
Nephrologists prefer PD if they themselves were diagnosed with ESRD16
- Given the choice, 91% of nephrologists surveyed would select home therapy compared to in-center dialysis.16
- At least 78% of ESRD patients have no medical contraindications for PD.17,18
PD safety and tolerability
- In a single-center, ex-U.S. study evaluating 1,656 patients for more than 20 years, overall peritonitis rates decreased significantly.19
- In a multicenter prospective study of 1,303 stage III–V chronic kidney disease patients, 78% were eligible for PD.17
Patients treated with PD have shown improved early survival within the first year compared to those treated with HD*,9
*PD patients may not experience an early peak in mortality, in part because patients starting ESRD via PD are a highly selected group, in many cases younger, healthier, and having undergone substantial pre-ESRD planning.
|First 2 months of therapy||Significantly lower mortality in PD vs. HD patients|
|After 12 months||Sustained lower mortality 9|
|At 12 months, mortality||