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

Background The 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. Methods Retrospective analysis was undertaken on consecutive incident adult patients on PD between 1 st January 2015-31 st 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. Results PD 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. Conclusions There 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 Points What was known The characterisation of healthcare-related activity to be expected with peritoneal dialysis therapy is not as comprehensive as that for haemodialysis and kidney transplantation. Patient-centred realistic medicine requires knowledge of the patient journey and the cumulative impact of healthcare activity interactions. Healthcare activity burden mapping is required to determine the necessary carbon emission reductions for reducing the contribution to climate change. This study adds An illustration of the associated health-care activity burden on patients commencing peritoneal dialysis. An indication of the carbon footprint associated with peritoneal dialysis health-care activity in the first year of therapy. Potential impact Informative for service providers of peritoneal dialysis in anticipating care requirements and planning carbon reduction strategies. Data can help inform patient decision making when receiving education of kidney replacement therapies.