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Original ArticlesMaintenance Dialysis
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A Systematic Review and Jurisdictional Scan of the Evidence Characterizing and Evaluating Assisted Peritoneal Dialysis Models

Mark Hofmeister, Scott Klarenbach, Lesley Soril, Nairne Scott-Douglas and Fiona Clement
CJASN April 2020, 15 (4) 511-520; DOI: https://doi.org/10.2215/CJN.11951019
Mark Hofmeister
1Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada;
2Health Technology Assessment Unit, O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada;
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Scott Klarenbach
4Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Lesley Soril
1Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada;
2Health Technology Assessment Unit, O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada;
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Nairne Scott-Douglas
3Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; and
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Fiona Clement
1Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada;
2Health Technology Assessment Unit, O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada;
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Background and objectives Compared with hemodialysis, home peritoneal dialysis alleviates the burden of travel, facilitates independence, and is less costly. Physical, cognitive, or psychosocial factors may preclude peritoneal dialysis in otherwise eligible patients. Assisted peritoneal dialysis, where trained personnel assist with home peritoneal dialysis, may be an option, but the optimal model is unknown. The objective of this work is to characterize existing assisted peritoneal dialysis models and synthesize clinical outcomes.

Design, setting, participants, & measurements A systematic review of MEDLINE, Cochrane Central Register of Controlled Trails, Cochrane Database of Systematic Reviews, Embase, PsycINFO, and CINAHL was conducted (search dates: January 1995–September 2018). A focused gray literature search was also completed, limited to developed nations. Included studies focused on home-based assisted peritoneal dialysis; studies with the assist provided exclusively by unpaid family caregivers were excluded. All outcomes were narratively synthesized; quantitative outcomes were graphically depicted.

Results We included 34 studies, totaling 46,597 patients, with assisted peritoneal dialysis programs identified in 20 jurisdictions. Two categories emerged for models of assisted peritoneal dialysis on the basis of type of assistance: health care and non–health care professional assistance. Reported outcomes were heterogeneous, ranging from patient-level outcomes of survival, to resource use and transfer to hemodialysis; however, the comparative effect of assisted peritoneal dialysis was unclear. In two qualitative studies examining the patient experience, the maintenance of independence was identified as an important theme.

Conclusions Reported outcomes and quality were heterogeneous, and relative efficacy of assisted peritoneal dialysis could not be determined from included studies. Although the patient voice was under-represented, suggestions to improve assisted peritoneal dialysis included using a person-centered model of care, ensuring continuity of nurses providing the peritoneal dialysis assist, and measures to support patient independence. Although attractive elements of assisted peritoneal dialysis are identified, further evidence is needed to connect assisted peritoneal dialysis outcomes with programmatic features and their associated funding models.

  • Caregivers
  • Developed Countries
  • Hemodialysis, Home
  • peritoneal dialysis
  • Qualitative Research
  • Narration
  • Patient Reported Outcome Measures
  • Cognition
  • Received October 7, 2019.
  • Accepted February 20, 2020.
  • Copyright © 2020 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 15 (4)
Clinical Journal of the American Society of Nephrology
Vol. 15, Issue 4
April 07, 2020
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A Systematic Review and Jurisdictional Scan of the Evidence Characterizing and Evaluating Assisted Peritoneal Dialysis Models
Mark Hofmeister, Scott Klarenbach, Lesley Soril, Nairne Scott-Douglas, Fiona Clement
CJASN Apr 2020, 15 (4) 511-520; DOI: 10.2215/CJN.11951019

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A Systematic Review and Jurisdictional Scan of the Evidence Characterizing and Evaluating Assisted Peritoneal Dialysis Models
Mark Hofmeister, Scott Klarenbach, Lesley Soril, Nairne Scott-Douglas, Fiona Clement
CJASN Apr 2020, 15 (4) 511-520; DOI: 10.2215/CJN.11951019
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