Clinical outcomes, quality of life, and costs evaluation of peritoneal dialysis management models in Shanghai Songjiang District: a multi-center and prospective cohort study.

Abstract

Background: The new Family-Community-Hospital (FCH) three-level comprehensive management aimed to improve the efficiency and scale of peritoneal dialysis (PD) to meet the increased population of end-stage renal disease (ESRD). Our study focused on the clinical outcomes, quality of life, and costs evaluation of this model in a multi-center and prospective cohort study.Methods: A total of 190 ESRD patients who commenced PD at Shanghai Songjiang District were enrolled. According to different PD management models, patients were divided into the Family-Community-Hospital three-level management model (n\u2009=\u200990) and the conventional all-course central hospital management model (n\u2009=\u2009100). The primary outcome was clinical outcomes of PD. The secondary outcomes were health-related quality of life (HRQOL) and medical costs evaluation.Results: Compared to conventional management, community-based FCH management achieved a similar dialysis therapeutic effect, including dropout rate (p\u2009=\u20090.366), peritonitis rate (p\u2009=\u20090.965), patient survival (p\u2009=\u20090.441), and technique survival (p\u2009=\u20090.589). Follow-up data showed that similar levels of the renal and peritoneal functions, serum albumin, cholesterol and triglyceride, PTH, serum calcium, and phosphorus between the two groups (all p\u2009>\u20090.05). HRQOL survey showed that the FCH management model helped to improve the psychological status of PD patients, including social functioning (p\u2009=\u20090.006), role-emotional (p\u2009=\u20090.032), and mental health (p\u2009=\u20090.036). FCH management also reduced the hospitalization (p\u2009=\u20090.009) and outpatient visits (p\u2009=\u20090.001) and saved annual hospitalization costs (p\u2009=\u20090.005), outpatient costs (p\u2009=\u20090.026), and transport costs (p\u2009=\u20090.006).Conclusions: Compared with conventional management, community-based FCH management achieved similar outcomes, improved psychological health, reduced medical budgets, and thus had a good social prospect.