The burden of patient healthcare activity in the first year of peritoneal dialysis

Background: The healthcare-related burden associated with kidney replacement therapy (KRT) has not been characterised as comprehensively in peritoneal dialysis (PD) as in haemodialysis (HD) or kidney transplantation. This study aimed to capture the nature and extent of healthcare activity in the first year of PD therapy. Methods: Retrospective analysis was undertaken on consecutive incident adult patients on PD between 1st January 2015-31st December 2019 in the Glasgow Renal and Transplant Unit. Healthcare-related activity was captured up to the first 365 days post-commencement of PD. Data was collected on renal service contact and activity relating to dialysis access, radiological investigation, and relevant infection episodes. Carbon mapping of healthcare activity was estimated using postcode data and previously published carbon footprint estimations. Results: PD was initiated in 122 patients over the study period. Sixty-three patients (52%) transitioned to another KRT within 365 days of commencing PD. Patients had a mean 36.4 days (SD 22.7) of face-to-face contact days with renal services. This included a mean of 1.5 (SD 1.6) hospital admissions, with a median 5 (IQR 10.8) in-patient days. The estimated carbon footprint was 581kg CO2e/patient over the incident year. This included a median 207kg CO2e/patient for inpatient days and 26kg CO2e/patient for treatment of infections. Conclusions: There is a significant burden of kidney-associated healthcare on patients commencing their first year of PD despite it being a home-based therapy. Estimates of carbon footprint indicate hotspots include patient travel and hospital admissions, and episodes of peritonitis; a full life cycle analysis is merited. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Caldicott guardian (Data protection office, NHS Greater Glasgow and Clyde, Scotland) approved the use of anonymised data for this work and waived ethical approval. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data generated and analysed during the current study are not publicly available, because informed consent to share data for secondary use beyond this analysis was not obtained from participants.