Abstract: FR-PO518
Predicting Transfer From Peritoneal Dialysis to Hemodialysis Using the Peritoneal Dialysis Surprise Question
Session Information
- Home Dialysis, Policy, Novel Approaches
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Anwaar, Ayesha, Stanford University, Stanford, California, United States
- Liu, Sai, Stanford University, Stanford, California, United States
- Nielsen, Hatsumi, Satellite Healthcare, San Jose, California, United States
- Montez-Rath, Maria E., Stanford University, Stanford, California, United States
- Abra, Graham E., Satellite Healthcare, San Jose, California, United States
- Sun, Sumi J., Satellite Healthcare, San Jose, California, United States
- Schiller, Brigitte, Satellite Healthcare, San Jose, California, United States
- Hussein, Wael F., Satellite Healthcare, San Jose, California, United States
Background
People on peritoneal dialysis (PD) at risk of transfer to hemodialysis (HD) need support to remain on PD or ensure a safe transition to HD. In this study, we evaluated the clinicians’ ability to identify high-risk patients.
Methods
In this prospective observational study, we included 1275 patients undergoing PD in 35 home programs of a non-profit dialysis organization. We modified the palliative care ‘Surprise Question’ to evaluate the risk of transfer to HD by asking the registered nurse (RN) and nephrologist (MD): “Would you be surprised if this patient transferred to HD in the next 6 months?” We called this the PD Surprise Question. A “yes”/ “no” answer indicated low/high risk respectively. We followed patients for 6 months. Using Cox proportional hazards regression we estimated the hazard ratio (HR) of transfer to HD.
Results
Patients’ mean age was 59 ± 16 years and 41% were female. The median PD vintage was 20 months (IQR: 9-40), and 92% were on automated PD.
Responses were received from RNs for 1123 patients, indicating 169 (15%) as high risk and 954 (85%) as low risk. Over the next 6 months, transfer to HD occurred in 18 (11%) versus 29 (3%) of the high and low-risk groups respectively (HR: 3.92, 95% confidence interval (CI): 2.17 – 7.05).
MD responses were obtained for 692 patients, indicating 118 (17%) and 574 (83%) as high and low risk respectively. Transfer to HD was observed in 14 (12%) of the high-risk group and 14 (2%) of the low-risk group (HR: 5.56, 95% CI: 2.65 – 11.67).
Conclusion
The PD Surprise Question can help identify patients at high risk of transfer to HD. This tool can be used to modify care to support patients to remain on PD or to prepare for safe and timely transfer to HD.