Growing Demand On Health Care Resources And Increased Incidence Of Kidney Disease Draw Attention To Peritoneal Dialysis On Its 30th Anniversary

Main Category: Urology / Nephrology
Also Included In: Medical Devices / Diagnostics
Article Date: 09 Oct 2008 - 9:00 PDT

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While peritoneal dialysis home therapy (PD) was originally introduced 30 years ago to offer patients with kidney failure a better way to filter toxins and fluids from the body overnight or several times a day in the convenience of their home, the economic advantages of PD have taken on increasing importance and visibility due to recent Centers for Medicare and Medicaid Services (CMS) rule changes and legislation affecting reimbursement and patient education.

As government officials, public health agencies and health care providers strive to expand access to health care and maximize their investments in public health, the burden of chronic diseases like end-stage renal disease (ESRD) grows. The incidence of ESRD is growing at a rate of approximately 1,505 per million population in the United States, fueled largely by diseases associated with an aging population, hypertension and increasing rates of diabetes. This growing burden is causing more officials and nephrologists to consider home-based therapies as a means of both offering patients greater convenience and potentially increasing levels of patient satisfaction and well-being, as well as helping maximize health resources by relieving some of the burden of capital investment, staffing and infrastructure.

In 2008, CMS released rule changes to the Conditions for Coverage that place greater emphasis on quality outcomes, patient education and improved administrative processes. Additionally, congress passed legislation that encourages dialysis facilities to maximize efficiencies through a bundled payment structure and affords kidney disease patients education benefits.

"USRDS data shows that patients on PD therapy generally have lower overall total healthcare costs per year compared to the total healthcare costs for patients on in-center hemodialysis. This might be attributed to the downstream cost differences in hospitalizations, infections and access maintenance, for example. Evidence also shows that PD is associated with equal or better survival in many patients," according to Jill Schaaf, general manager, Baxter's Renal business.

Worldwide, the proportion of patients with ESRD treated with home-based peritoneal dialysis versus in-center hemodialysis differs considerably from country to country - from as low as approximately 8 percent in the United States to as much as over 80 percent in Hong Kong, according to the 2007 USRDS International Report.

Says Schaaf, "Current evidence shows that PD has excellent clinical results based on survival and morbidity data, and other data indicate that it is currently under-utilized." Evidence may suggest a correlation between PD home therapy choice and employment.

"We are not sure if patients who want to continue working choose home PD or if patients on home PD find it easier to continue to work," says Schaaf. "Regardless, home dialysis offers more time for work, family and social activities and a correlation between a choice of home dialysis and employment is clear."

Some researchers suggest that this correlation is related to the improved well-being most patients claim they experience on PD home therapy. Throughout the years, dialysis-related infection rates and patient outcomes have improved with intelligent PD system design, a reduced number of connections, the development of sophisticated and more biocompatible PD solutions and the addition of automated peritoneal dialysis (APD) in 1994 when Baxter launched the HomeChoice APD system. The HomeChoice system allows patients to carry out dialysis every night, resulting in increased freedom during the day.

This may yield other indirect savings as well. Patients who feel better and can receive their therapy at more convenient times and locations may be in a better position to continue working, caring for their children or family members, or otherwise contributing to their communities' economies.

Patient Judy Martin, age 66, of Marietta, Georgia, has used PD home therapy for 22 years and believes that it affords her a better quality of life. She claims she has more energy with PD than when she briefly tried hemodialysis (HD) 22 years ago because frequent exchanges keep her body clear of toxins. She has continued to be active, going to her two grandsons' soccer games, educating and supporting other PD patients, traveling and playing bridge with friends.

"I've always been a homemaker, so I wanted to be at home and I wanted to feel good. I just felt so much better on PD because I could do exchanges more frequently than when I was on hemodialysis," says Martin.

Several studies have shown patients who are objectively informed about dialysis modality options and given free choice more often choose PD home therapy or other self-care dialysis than do uninformed patients.

In celebration of 30 years of PD leadership and home therapy development, Baxter is committed to raising awareness about patient choice, advancing the innovation of better home therapies, and bringing PD, a cost-effective alternative to HD, to developing economies.

"We are absolutely committed to offering patients around the world a dialysis option that allows them to feel good and retain as much renal function as they can as their disease progresses, whether they live in a developed or an emerging economy," says Sarah Prichard, MD, vice president of global clinical affairs for Baxter's Renal business. "Our hope is that, during this year in which we celebrate a significant advancement in the care of kidney disease, patients continue to advocate for the option to choose their own therapy and governments take note of both the clinical and the economic benefits of PD home therapy."

About PD Home Therapy

Beginning in October of 1978 with the FDA's approval of the first available PD solution in a 2-liter closed system developed by Baxter, patients on PD could perform dialysis therapy in the comfort of their home for the first time.

Hundreds of thousands of patients worldwide have been treated with PD since it became available 30 years ago. Unlike HD, in which patients generally go to a hospital or clinic several times a week to have their blood pumped through an external filter, or dialyzer, PD is a home therapy that uses the body's own peritoneum - the lining of the abdominal cavity - as a filter to cleanse the blood.

In PD home therapy, patients infuse dialysis solution into their peritoneal cavity through a surgically implanted catheter in their abdomen. The solution draws toxins, waste and excess fluid from the bloodstream across the peritoneal membrane into the solution, which is then drained from the abdomen and discarded.

Baxter has developed almost every major milestone in this therapy (advanced dialysis solutions, containers and delivery systems). Baxter first commercialized and launched PD home therapy after receiving FDA approval in October of 1978 in the United States. Baxter then developed the Twin Bag CAPD System, followed by HomeChoice and HomeChoice Pro APD cyclers, which redefined how PD therapy is delivered in the home, and is still the market leader in the industry today.

About Baxter

Baxter International Inc. develops, manufactures and markets products that save and sustain the lives of people with hemophilia, immune disorders, cancer, infectious diseases, kidney disease, trauma, and other chronic and acute medical conditions. As a global, diversified health care company, Baxter applies a unique combination of expertise in medical devices, pharmaceuticals and biotechnology to create products that advance patient care worldwide.

Baxter International Inc.