Introduction:
Peritoneal Dialysis (PD) utilization declined dramatically in Thailand, following the 2022 shift from the “PD First” policy to one where patients may select their preferred dialysis modality. While the new policy offers greater patient choice, its aftermath included lowered In-Centre Hemodialysis quality due to service capacity overload, a sharp increase in the dialysis budget, and a severely threatened PD ecosystem due to reduced patient volumes. To mitigate these effects, a government-commissioned working group (WG) recommended increasing PD utilization from 15% to 50%. Therefore, to inform the WG of practical pathways to meet the ambitious goal, we conducted a scoping review of non-therapeutic interventions aimed at increasing the utilization of Home Dialysis (HoD), including both PD and Home Hemodialysis (HHD), to assess the effects and costs of implementing the interventions on the uptake and retention of HoD utilization across the world. HHD was included as the lessons learned from HHD provision in high-income countries may be applicable to PD provision in middle-income contexts too.
Methods:
Relevant studies were identified through a comprehensive search in the Web of Science, PubMed, Embase, Scopus, EBSCOhost, and EconLit databases. The search was conducted in June 2024 with no restrictions on the time period. Titles and abstracts of identified studies were selected by one reviewer, while full texts were selected independently by two reviewers. Primary studies which aim to increase the utilization of HoD, and whose impact were reported in terms of HoD uptake, retention, or utilization were included; meanwhile, studies with a therapeutic intervention (e.g., new dialysate), narrative reviews and qualitative studies were excluded. Data regarding the goal and impact of each strategy, target population, and the context of the study were extracted from the selected studies.
Results:
Comprehensive searching yielded 25,057 studies. After removing the duplicates, 17,253 studies were screened for their eligibility, and 45 studies were included in the review. The interventions could be classified into three groups: education, payment, and service provision. Preliminary analysis reflects that most interventions were targeted toward patients, with education-related interventions being the most prevalent, followed by service provision and payment-related interventions. Pre-dialysis patient education by multidisciplinary care teams and adjusting dialysis to a bundled payment system that offers providers a higher margin for HoD was effective in increasing HoD utilization. Service-related interventions such as implementing data-driven management can also improve the quality of HoD care. Additionally, training nephrologists in PD catheter insertion was an effective strategy to increase PD utilization in contexts where PD uptake was initially low. However, the implementation costs of the interventions were not reported in detail.
Conclusions:
Purposeful patient education, catheter insertion by nephrologists, data-driven management, and bundling dialysis payments are effective interventions to improve home dialysis utilization. Future research should also report implementation costs to reflect the feasibility of the intervention.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.