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Adherence of pediatric patients to automated peritoneal dialysis
Annabelle N Chua1, Bradley A Warady
1Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA. anchua@texaschildrenshospital.org
Insights
Many pediatric patients on home automated peritoneal dialysis (APD) show non-adherence to their prescribed treatment. Close monitoring of pediatric home dialysis is essential for effective end-stage renal disease management.
Area of Science:
- Nephrology
- Pediatric Dialysis
Background:
- Adherence to home automated peritoneal dialysis (APD) prescriptions in pediatric patients with end-stage renal disease (ESRD) is not well-documented.
- Home dialysis offers an alternative for managing ESRD in children, but requires strict adherence to treatment protocols.
Purpose of the Study:
- To retrospectively analyze adherence to home APD prescriptions in pediatric patients.
- To identify factors associated with non-adherence in this population.
Main Methods:
- Retrospective review of HomeChoice PRO Card data from 51 pediatric patients (<21 years) undergoing home APD.
- Adherence was quantified for four variables: sessions/month, session duration, cycles/session, and dialysate volume.
- Statistical analysis assessed the relationship between adherence and patient demographics (age, gender, race) and training status.
Main Results:
- 55% of pediatric patients were fully adherent to all APD prescription variables.
- Non-adherence was more prevalent in males (p=0.026) and African Americans (p=0.048).
- Higher adherence rates were observed for session duration (96%) and cycles/session (92%), while non-adherence was more common for sessions/month (82%) and dialysate volume (78%).
Conclusions:
- Approximately 45% of pediatric patients exhibited some level of non-adherence to their prescribed APD regimen.
- Findings highlight the need for continuous monitoring of home dialysis performance in children.
- Understanding adherence patterns is crucial for optimizing treatment outcomes in pediatric ESRD.
Abstract:
Little information is available on adherence to a home automated peritoneal dialysis (APD) prescription for children with end-stage renal disease. We have therefore retrospectively reviewed HomeChoice PRO Card data from patients <21 years of age who received home APD. Adherence was characterized as occurring ≥ 95%, 90-94%, or <90% of time by dividing the frequency of each of four measured prescription variables (sessions/month, duration of each session, number of cycles/session, volume of dialysate/session) by the prescribed frequency and multiplying by 100. The relationship between treatment adherence and patient age, gender, race and if the patient had received training, respectively, was assessed. Of the 51 patients (57% male), with a mean age at peritoneal dialysis (PD) onset of 11.8 ± 5.3 years, 28 (55%) were adherent for all variables. No difference in mean age or if patients were trained existed between the two groups. Males were more likely to be non-adherent (p = 0.026) as were African Americans (p = 0.048). The majority of patients were adherent to duration (96%) and number of cycles (92%), whereas non-adherence was more common with number of sessions (82%) and dialysate volume (78%). In conclusion, 45% of the pediatric patients in our study cohort exhibited some non-adherence to their prescribed APD regimen, emphasizing the value of closely monitoring the performance of home dialysis in children.
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