Predicting transfer to haemodialysis using the peritoneal dialysis surprise question

Area of Science:

• Nephrology
• Clinical Risk Stratification
• Dialysis Management

Background:

• Patients on peritoneal dialysis (PD) may require transfer to haemodialysis (HD).
• Effective risk stratification tools are needed to manage dialysis resources and patient care.
• Identifying patients at high risk for PD to HD transfer is crucial for timely support.

Purpose of the Study:

• To evaluate a simple point-of-care question for identifying patients at high risk of transfer from PD to HD.
• To assess the utility of the "surprise question" (SQ) in predicting transfer to HD and other adverse outcomes.

Main Methods:

• A prospective observational study of 1275 patients on PD across 35 home dialysis programs.
• Modified the palliative care "surprise question" (SQ): "Would you be surprised if this patient transferred to HD in the next six months?"
• Registered nurses and nephrologists answered the SQ; patient outcomes were followed for 6 months.

Main Results:

• Nurses identified 15% of patients as high risk; 11% transferred to HD compared to 3% of low-risk patients (HR: 3.92).
• Nephrologists identified 17% as high risk; 12% transferred to HD compared to 2% of low-risk patients (HR: 5.56).
• High-risk patients had increased rates of death and hospitalization; peritonitis rates were similar.

Conclusions:

• The Peritoneal Dialysis Surprise Question (PDSQ) is a simple, effective point-of-care tool.
• PDSQ aids in identifying patients at high risk for transfer to HD and other adverse outcomes.
• This tool can help optimize resource allocation and patient management in dialysis centers.