The burden of patient healthcare activity in the first year of peritoneal dialysis

BackgroundThe healthcare-related burden associated with kidney replacement therapy (KRT) has not been characterised as comprehensively in peritoneal dialysis (PD) as in haemodialysis (HD) or kidney transplantation. This study aimed to capture the nature and extent of healthcare activity in the first year of PD therapy. MethodsRetrospective analysis was undertaken on consecutive incident adult patients on PD between 1st January 2015-31st December 2019 in the Glasgow Renal and Transplant Unit. Healthcare-related activity was captured up to the first 365 days post-commencement of PD. Data was collected on renal service contact and activity relating to dialysis access, radiological investigation, and relevant infection episodes. Carbon mapping of healthcare activity was estimated using postcode data and previously published carbon footprint estimations. ResultsPD was initiated in 122 patients over the study period. Sixty-three patients (52%) transitioned to another KRT within 365 days of commencing PD. Patients had a mean 36.4 days (SD 22.7) of face-to-face contact days with renal services. This included a mean of 1.5 (SD 1.6) hospital admissions, with a median 5 (IQR 10.8) in-patient days. The estimated carbon footprint was 581kg CO2e/patient over the incident year. This included a median 207kg CO2e/patient for inpatient days and 26kg CO2e/patient for treatment of infections. ConclusionsThere is a significant burden of kidney-associated healthcare on patients commencing their first year of PD despite it being a home-based therapy. Estimates of carbon footprint indicate hotspots include patient travel and hospital admissions, and episodes of peritonitis; a full life cycle analysis is merited. Key Learning PointsO_ST_ABSWhat was knownC_ST_ABSO_LIThe characterisation of healthcare-related activity to be expected with peritoneal dialysis therapy is not as comprehensive as that for haemodialysis and kidney transplantation. C_LIO_LIPatient-centred realistic medicine requires knowledge of the patient journey and the cumulative impact of healthcare activity interactions. C_LIO_LIHealthcare activity burden mapping is required to determine the necessary carbon emission reductions for reducing the contribution to climate change. C_LI This study addsO_LIAn illustration of the associated health-care activity burden on patients commencing peritoneal dialysis. C_LIO_LIAn indication of the carbon footprint associated with peritoneal dialysis health-care activity in the first year of therapy. C_LI Potential impactO_LIInformative for service providers of peritoneal dialysis in anticipating care requirements and planning carbon reduction strategies. C_LIO_LIData can help inform patient decision making when receiving education of kidney replacement therapies. C_LI