Blake PG, Floyd J, Spanner E, Peters K
How much additional expense is incurred whan an "adequacy
program" is implmented in the peritoneal dialysis unit
XVIth Annual CAPD Conference
Perit Dial Int Suppl 2
(Feb) 16:S19 1996
This abstract deals with the extra financial cost associated with use of
urea kinetic modeling to monitor and increase when necessary, the dose of
peritoneal dialysis in CAPD and APD patients. In a 37 patient program
Kt/V was measured quaterly. When
necessary the amount of dialysate used was increased to achieve a weekly
urea KT/V of 1.5 to 1.7. Thirteen percent of patients had their
prescription altered to obtain the target Kt/V. Dwell volumes were
increased in 5 CAPD patients whereas 6 other CAPD patients were switched
to high volume APD. Two additional APD patients had their total dialysate
volume increased. The total annualised cost of dialysate and delivery
systems was increased by 16%, an average $2,300 per patient. This does not
include extra laboratory and staff costs associated with modeling.
The authors conclude that "the application of an adequacy policy in PD
involves a significant increment in costs and will hopefully be justified
by improved outcomes."
Comment: The study is provocative and original.
The real cost of "adequate" or "inadequate" treatment
is complicated to evaluate. No treatment at all would
obviously be cheapest but there is no doubt that underdialysis
might have morbid consequences which generate their own extra cost.
This study is a first step toward a more sophisticated protocol which
needs to be devised to evaluate the true cost of dialysis adequacy
evaluation and correction. (Christian Verger, M.D., Pointoise,
France)
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XVIth Annual CAPD Conference
Basic peritoneal dialysis :
Chronic PD regimens, adequacy, modeling