Clinical outcomes, quality of life, and costs evaluation of peritoneal dialysis management models in Shanghai Songjiang District: a multi-center and prospective cohort study

Ren Fail. 2021 Dec;43(1):754-765. doi: 10.1080/0886022X.2021.1918164.

Abstract

Background: The new Family-Community-Hospital (FCH) three-level comprehensive management aimed to improve the efficiency and scale of peritoneal dialysis (PD) to meet the increased population of end-stage renal disease (ESRD). Our study focused on the clinical outcomes, quality of life, and costs evaluation of this model in a multi-center and prospective cohort study.Methods: A total of 190 ESRD patients who commenced PD at Shanghai Songjiang District were enrolled. According to different PD management models, patients were divided into the Family-Community-Hospital three-level management model (n = 90) and the conventional all-course central hospital management model (n = 100). The primary outcome was clinical outcomes of PD. The secondary outcomes were health-related quality of life (HRQOL) and medical costs evaluation.Results: Compared to conventional management, community-based FCH management achieved a similar dialysis therapeutic effect, including dropout rate (p = 0.366), peritonitis rate (p = 0.965), patient survival (p = 0.441), and technique survival (p = 0.589). Follow-up data showed that similar levels of the renal and peritoneal functions, serum albumin, cholesterol and triglyceride, PTH, serum calcium, and phosphorus between the two groups (all p > 0.05). HRQOL survey showed that the FCH management model helped to improve the psychological status of PD patients, including social functioning (p = 0.006), role-emotional (p = 0.032), and mental health (p = 0.036). FCH management also reduced the hospitalization (p = 0.009) and outpatient visits (p = 0.001) and saved annual hospitalization costs (p = 0.005), outpatient costs (p = 0.026), and transport costs (p = 0.006).Conclusions: Compared with conventional management, community-based FCH management achieved similar outcomes, improved psychological health, reduced medical budgets, and thus had a good social prospect.

Keywords: Peritoneal dialysis; clinical outcomes; costs evaluation; management model; quality of life.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • China
  • Female
  • Hospitalization / economics
  • Humans
  • Kidney Failure, Chronic / economics
  • Kidney Failure, Chronic / psychology
  • Kidney Failure, Chronic / therapy*
  • Male
  • Mental Health
  • Middle Aged
  • Peritoneal Dialysis / adverse effects*
  • Peritoneal Dialysis / economics
  • Peritonitis / epidemiology
  • Peritonitis / etiology*
  • Prospective Studies
  • Quality of Life*

Grants and funding

This study was supported by the National Nature Science Foundation of China grants [82070791, 81670690, 81470991, and 81200492 to N.L., 82070700, 81830021 and 81670623 to S.Z., 81970072 and 81500059 to L.T.]; the Shanghai Scientific Committee Foundation of China [20ZR1445800 and 13PJ1406900 to N.L., 15411971200 to X.Z., 20Y11901200 to L.T.]; the Key Discipline Construction Project of Pudong Health Bureau of Shanghai [PWZxk2017-05 to N.L.]; the Shanghai Integration of Chinese and Western Medicine Foundation [SH201737 to X.Z.]; the Shanghai Songjiang District Science and Technology Project [19sjkjgg71 to X.Z.]. the Key Program of Science Foundation of Jiangxi Province [2018ACB 20016 to L.T.], the Leading Medical Talent Project of Shanghai Pudong Heath Bureau [PWRI2019-05 to L.T.]; Branch Grant of National Key R&D Program of China [2018YFA0108802 to S.Z.].