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Background: Kinesiophobia, an irrational fear-avoidance behaviour, can significantly impact the quality of life and prognosis of peritoneal dialysis patients. This study aimed to assess the prevalence of kinesiophobia in patients undergoing peritoneal dialysis and to analyse its influencing factors., Methods: A total of 291 patients who visited the outpatient and ward of peritoneal dialysis in 7 tertiary hospitals in Jiangsu Province from December 2023 to March 2024 were selected as research subjects via the convenience sampling method. A cross-sectional survey was conducted using a general data questionnaire, the Tampa Kinesiophobia-11 Scale, the Chinese Version of the Multidimensional Fatigue Symptom Scale, and the Simplified Coping Style Questionnaire., Results: The score obtained using the Tampa Scale for kinesiophobia in patients with peritoneal dialysis was 22.44 ± 7.46, with a prevalence rate of 69.1%. Binary logistic regression analysis revealed that no complications, daily exercise before illness, and positive coping styles were protective factors (p < 0.05), whereas fatigue and negative coping styles were risk factors for kinesiophobia in patients receiving peritoneal dialysis (p < 0.05)., Conclusions: The prevalence of kinesiophobia in patients receiving peritoneal dialysis was high but at a mild level. Medical staff should combine influencing factors to identify high-risk groups as early as possible, formulate targeted interventions to reduce the occurrence of kinesiophobia and mitigate adverse effects on peritoneal dialysis patients., Competing Interests: Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine (2023NL-277-02). Informed consent was obtained from all the subjects involved in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: End-stage renal disease is different from other chronic diseases that the treatment method is as difficult. Our aim in this study was to compare marital adjustment, sexual functions and family functioning between hemodialysis (HD) and peritoneal dialysis (PD) patient., Method: A total of 21 HD and 27 PD patients were included. Beck Depression Inventory (BDI), Short Form-36 (SF-36), Pittsburgh Sleep Quality Index (PSQI), Arizona Sexual Experiences Scale (ASEX), Golombok-Rust Inventory for Sexual Satisfaction (GRISS), Marital Adjustment Test (MAT) and Family Assessment Device (FAD) were applied., Results: BDI scores were significantly higher in HD patients (p < 0.001). According to FAD problem solving (p < 0.001), communication (p = 0.00) and general functioning scores (p = 0.04) were higher in PD. The rate of poor sleep quality was 44.4% in the PD group, and 66.7% in HD group (p = 0.12). General health (p = 0.04), vitality (p < 0.001), mental health (p = 0.00) and social functioning (p = 0.00) scores were lower in HD patients., Conclusion: HD patients are at high risk for psychiatric disorders due to the treatment modality. These patients should be monitored carefully and consultation-liaison services should be increased., (© 2024 International Society for Apheresis and Japanese Society for Apheresis.)

Background: Peritoneal dialysis (PD) is a home-based kidney replacement therapy (KRT) performed in people with kidney failure. PD can be performed by manual filling and draining of the abdominal cavity, i.e. continuous ambulatory PD (CAPD), or using a device connected to the PD catheter that is programmed to perform PD exchanges, i.e. automated PD (APD). APD is considered to have several advantages over CAPD, such as a lower incidence of peritonitis, fewer mechanical complications, and greater psychosocial acceptability. Acknowledging the increasing uptake of APD in incident and prevalent patients undergoing PD, it is important to re-evaluate the evidence on the comparative clinical and patient-reported outcomes of APD compared to CAPD. This is an update of a Cochrane review published in 2007., Objectives: To compare clinical and patient-reported outcomes of APD to CAPD in people with kidney failure., Search Methods: In this update, we searched the Cochrane Kidney and Transplant Register of Studies until 29 August 2024. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov., Selection Criteria: Randomised controlled trials (RCTs) comparing APD with CAPD in adults (≥ 18 years) with kidney failure., Data Collection and Analysis: Two authors independently screened the search results and extracted data. Data synthesis was performed using random-effects meta-analyses, expressing effect estimates as risk ratios (RR) with 95% confidence intervals (CI) for dichotomous data and mean differences (MD) with 95% CIs for continuous data. Certainty in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach., Main Results: Two RCTs (131 randomised people) comparing APD with CAPD were included in this update. One RCT had a follow-up of six months, and one RCT had a follow-up of 24 months. The risk of bias in the included studies was mostly low, except for the high risk of performance bias for subjective outcomes. The evidence is very uncertain about the effect of APD compared to CAPD on death, hospitalisations, PD-related peritonitis, change of dialysis modality, residual kidney function, health-related quality of life (HRQoL), overhydration, blood pressure, exit-site infections, tunnel infections, mechanical complications, PD catheter removal, or dialysis adequacy measures. These results were largely based on low to very low certainty evidence; hence, caution is warranted when drawing conclusions., Authors' Conclusions: Insufficient evidence exists to decide between APD and CAPD in kidney failure patients with regard to clinical and patient-reported outcomes. Therefore, current evidence is insufficient as a guide for clinical practice. Given that the sample sizes of existing studies are generally small with insufficient follow-up, there is a need for large-scale, multicentre studies. Future research should focus on possible differences between APD and CAPD in residual kidney function, euvolaemia, and patient-reported outcomes such as HRQoL, symptoms, patient satisfaction and life participation., (Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Aim: The purpose of the study was to investigate and analyse inner strength of patients with peritoneal dialysis, explore the associations among inner strength, coping self-efficacy (CSE) and medial coping modes., Design: This was a cross-sectional study which was conducted in nephrology departments of two affiliated hospitals of a comprehensive university in China. Convenience sampling was chosen to collect data., Methods: A total of 191 patients undergoing peritoneal dialysis were recruited by convenience sampling in two hospitals. Data involved of sociodemographic and clinical materials, inner strength, CSE and medical coping modes were collected from the patients. IBM SPSS Statistics 21.0 was used to process and analyse the data., Results: The averaged score of inner strength was 95.74 (SD = 13.52). The inner strength, CSE and confrontation coping had positive associations with each other. Besides, inner strength and CSE was negatively associated with acceptance-resignation coping strategy, respectively., (© 2024 The Author(s). Nursing Open published by John Wiley & Sons Ltd.)

Introduction: Peritoneal dialysis (PD) is an alternative modality to hemodialysis (HD) for end-stage Kidney disease (ESKD) treatment. However, PD is underutilized, and patients' knowledge about PD is crucial in making an informed decision about the dialysis modality. This study aims to evaluate the knowledge about PD among HD patients and explore the reasons for its underutilization., Materials and Methods: A cross-sectional study of 108 HD patients was conducted from August to November 2023, at Al-Jaber Dialysis Center in Al-Ahsa. They interviewed to assess the knowledge about PD and explore the reasons for its underutilization., Results: The patients' ages ranged from 20 to 80 years, with a mean age of 44.2 years. Regarding knowledge about PD, 81.5% of the ESKD patients had heard about other renal replacement modalities, with kidney transplant being the most commonly known option. Only 11.1% were aware of both kidney transplants and PD. 60.2% of patients reported that their nephrologists had discussed other treatment options with them. However, overall knowledge about PD among patients was relatively low, with 43.5% having good knowledge and 56.5% having poor knowledge. Lack of information, considering HD as a better method, and fear of complications were the primary reasons for not considering PD as the first treatment option., Conclusion: This study highlights the inadequate knowledge about PD among HD patients and identifies factors contributing to the underutilization of PD. Lack of information, misconceptions about the effectiveness and safety of PD, and preference for HD were significant barriers. Enhancing patient education and addressing misconceptions are crucial in promoting PD as a viable treatment option for ESKD, thereby improving patients' quality of life.

Objective: Depression has become a highly prevalent mental disorder around the globe. With a large number of end-stage renal disease patients taking up peritoneal dialysis (PD), a substantial number of PD patients with concomitant depression are expected to be treated in the future. However, the effects of depression on outcomes of PD are unclear. This review systematically examines the effect of depression on mortality, technique survival, or peritonitis in PD patients., Materials and Methods: Studies comparing outcomes of PD patients with and without depression and published on Google Scholar, Embase, Web of Science, and PubMed till February 5, 2024 were included., Results: Eleven studies were eligible; 5 studies reported data on mortality. Pooled analysis showed that depression was not a significant predictor of mortality in PD patients (HR: 1.22 95% CI: 0.86, 1.72). Only 2 studies reported analyzable data on technique survival and 3 studies on peritonitis. Meta-analysis found no statistically significant effect of depression on technique survival (OR: 1.28 95% CI: 0.38, 4.35) and peritonitis (OR: 1.89 95% CI: 0.82, 4.33). Qualitative analysis of remaining studies also suggested no effect of depression on patient and technique survival., Conclusion: Depression may not be an independent predictor of patient and technique survival in PD patients. Data on the risk of peritonitis is conflicting and needs to be investigated further.

Background: This study aimed to explore in depth the lived experience and quality of life outcomes in patients receiving automated peritoneal dialysis (APD) treatment., Methods: The study adhered to the standards of the Consolidated Criteria for Reporting Qualitative Research. A total of 19 APD patients were recruited and assessed using in-depth semi-structured interviews on various aspects of life with respect to APD modality. The interviews were transcribed verbatim and analyzed using Interpretive Phenomenological Analysis., Results: Study findings generated five superordinate themes: (a) treatment-free daily routine, (b) sleep disturbances, (c) remote care, (d) limitations of peritoneal dialysis, and (e) the dimension of chronic disease. Further analysis of the material revealed the relationship of these themes with individual patient characteristics., Conclusions: Overall, our findings suggest that APD characteristics contribute to the perceptions of quality of life in patients under dialysis considerably., (© 2024 The Author(s). Therapeutic Apheresis and Dialysis published by John Wiley & Sons Australia, Ltd on behalf of International Society for Apheresis and Japanese Society for Apheresis.)

Background: Social determinants of health (SDoH) are increasingly recognized as crucial factors affecting the well-being of pediatric chronic kidney disease (CKD) patients. This study explores the impact of SDoH on the quality of life (QoL) of children with CKD in Saudi Arabia., Methods: This observational, descriptive, cross-sectional study included 50 participants with CKD stages three to five, as well as children with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD) or hemodialysis (HD) in Riyadh, Saudi Arabia. Data were collected from children and their caregivers using a validated Arabic-adapted version of the Pediatric Quality of Life Inventory (PedsQL) 3.0 and an SDoH survey., Results: The study revealed that access to education significantly affects pediatric QoL (H/Z score 2.825; P-value 0.005), and the lack of dietary recommendations was identified as a critical factor (H/Z score 1.441; P-value 0.029). ESRD patients on PD from larger families reported better QoL, whereas lower family income was associated with reduced QoL in PD patients (P-value 0.048). Compared to those in earlier stages of CKD, ESRD patients showed lower QoL (H/Z score 2.154; P-value 0.031)., Conclusion: Our study provides initial insights into the relationship between SDoH and the QoL of children with CKD in Saudi Arabia. It calls for a comprehensive approach that includes these determinants in care strategies to improve patient outcomes and QoL., (© 2024. The Author(s).)

Background: High-quality patient-reported outcome (PRO) measures for dialysis patients with chronic pruritus are urgently needed. However, no known, well-validated multidimensional tools have been investigated to measure pruritus symptoms in dialysis patients., Objectives: To examine the psychometric properties of a multidimensional tool of chronic pruritus, the Uraemic Pruritus in Dialysis patients (UP-Dial) 14-item scale, by comparing haemodialysis and peritoneal dialysis modality., Methods: This validation study used data from the Thai Renal Outcomes Research-Uraemic Pruritus, a prospective, multicentre, longitudinal study. Data for this study were collected from 1 February 2019 to 31 May 2022. The adult sample of 226 haemodialysis and 327 peritoneal dialysis patients fulfilled the criteria of chronic pruritus based on the International Forum for the Study of Itch. Psychometric properties of the UP-Dial included validity and reliability, as measured across haemodialysis and peritoneal dialysis patients. Patients completed a set of anchor-based measurement tools, including global itching, Dermatology Life Quality Index (DLQI), EuroQoL-5 dimension-5 level (EQ-5D-5L), Kidney Disease Quality of Life-36 (KDQOL-36), Pittsburgh Sleep Quality Index (PSQI), global fatigue, Somatic Symptom Scale-8 (SSS-8) and Patient Health Questionnaire-9 (PHQ-9)., Results: From the patient's perspective, face validity was satisfactory for both dialysis samples. Psychometric analyses of the UP-Dial for each dialysis sample had good convergent validity. Spearman rho correlations indicate a positively strong correlation (0.73-0.74) with global itching, a positively moderate correlation (0.33-0.58) with DLQI, PSQI, global fatigue, SSS-8 and PHQ-9, and a negatively moderate correlation (-0.39 to -0.58) with EQ-5D-5L and KDQOL-36. The discriminant validity was satisfactory with a group of moderate and severe burden of pruritus for both dialysis samples. For scale reliability, the UP-Dial revealed excellent internal consistency (Cronbach's α = 0.89 and McDonald's ω = 0.90) and reproducibility (intraclass correlation 0.84-0.85) for both dialysis samples. Regarding psychometric properties, no statistically significant differences between dialysis samples were observed (all P > 0.05)., Conclusions: The findings reaffirm good measurement properties of the UP-Dial 14-item scale in haemodialysis and peritoneal dialysis patients with chronic pruritus. These suggest a transferability of the UP-Dial as a PRO measure in clinical trial and practice settings., Competing Interests: Conflicts of interest M.M.S. is an advisor/consultant for AstraZeneca, Bayer, GlaxoSmithKline (GSK) and Otsuka. J.A.B. is a consultant and has received research grants from Allakos, Amgen, AstraZeneca, Celldex, Escient, Genentech, GlaxoSmithKline (GSK), Jasper, Novartis and Sanofi Regeneron; has a leadership or fiduciary role in the American Academy of Allergy, Asthma & Immunology (president); Hereditary Angioedema Association (member activities board); Interasma (vice president); and the World Allergy Organization (board of directors). J.C.S. is an advisor/consultant for AbbVie, Leo Pharma, Novartis, Pfizer, Sanofi-Genzyme, Trevi, UCB and Vifor; is a speaker for AbbVie, Almirall, Eli-Lilly, Janssen-Cilag, Leo Pharma, Novartis, Pfizer and Sanofi-Genzyme; is an investigator (principal investigator in clinical trials) for AbbVie, Almirall, Amgen, AnaptysBio, BMS, Boehringer Ingelheim, Celtrion, Galapagos, Galderma, Helm AG, Incyte, InfraRX, Janssen-Cilag, Kliniksa, Leo Pharma, Medimmune, Menlo Therapeutics, Merck, Novartis, Pfizer, Regeneron, Teva, Trevi and UCB; and has a leadership or fiduciary role in the Polish Dermatological Society (president). The other authors declare that they have no relevant conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Aim: This study aims to assess the extent of social alienation in patients undergoing peritoneal dialysis and examine how personal mastery and perceived social support mediate the association between emotional intelligence and social alienation in this patient population., Methods: This study adopts a cross-sectional survey design. A total of 192 patients were recruited from a tertiary hospital located in Henan Province, China, using a convenience sampling method. We have developed a structural equation model to investigate the mediating influence of personal mastery and perceived social support on the emotional intelligence and social alienation of patients undergoing Peritoneal dialysis., Results: Peritoneal patients exhibited an social alienation score of 42.01 ± 3.15. Elevated EI levels (coefficient = -0.616, p  < 0.001) were significantly correlated with reduced social alienation. The mediation model demonstrated that personal mastery and perceived social support fully mediated the impact of emotional intelligence on social alienation., Conclusion: The social alienation of peritoneal dialysis patients is serious, and healthcare professionals should pay attention to patients' social alienation, improve patients' emotional intelligence through relevant interventions, increase personal mastery and perceived social support, and finally reduce social alienation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Diao, Wang, Zhang, Huang and Shan.)

Background: Peritonitis is the main treatment-related complication of peritoneal dialysis and a primary concern for patients and their relatives. Therefore, understanding their perceptions of peritonitis is important., Objectives: To explore patients' and relatives' perceptions of peritoneal dialysis-associated peritonitis risk, prevention measures and experiences of diagnosis, and experience of perceived stigma., Design: A sequential mixed methods study design was used, including a questionnaire and semi-structured interviews., Participants: Patients using peritoneal dialysis and relatives (n = 75) from six National Health Service organisations from the United Kingdom., Measurements: A structured questionnaire was administered with patients and relatives (n = 75) using peritoneal dialysis; data were analysed using descriptive statistics. Thirty questionnaire respondents were then purposively sampled and interviewed in-depth; data were analysed thematically. Data were collected 2017-2018. Ethical and governance approvals were gained., Results: Qualitative and quantitative analyses were integrated and three themes presented: • Perceptions of risk: participants assessed their risk of developing peritonitis and possible implications on their health and relatives. Participants felt greatly responsible for preventing infection. • Preventing peritonitis: participants reported similar and some differing measures to minimise their risk of developing peritonitis. Participants wanted to be seen as "clean". • Diagnosis of peritonitis: peritonitis diagnosis was embarrassing and stigmatising for many individuals. This was influenced by the response of healthcare professionals and the cause of peritonitis., Conclusions: It is important that healthcare professionals are aware of how responsible patients and relatives feel about preventing peritonitis, the emotional effect of this responsibility and crucially the impact this may have on seeking help., (© 2023 The Authors. Journal of Renal Care published by John Wiley & Sons Ltd on behalf of European Dialysis & Transplant Nurses Association/European Renal Care Association.)

Background: People treated with home dialysis report social and emotional isolation, fear of catastrophic events and concern about being a burden. There is a paucity of research exploring psychological well-being among consumers dialysing at home. We aimed to explore the psychological health issues related to home dialysis, and how these issues may impact on sustaining home-based treatment., Methods: We conducted a qualitative interview study with 36 consumers. We included patients with experience of home dialysis and caregivers. Thirteen participants had experienced peritoneal dialysis, seven home haemodialysis, seven had experienced both and nine caregivers. Data were analysed inductively to generate themes and a conceptual framework., Results: We identified four themes and subthemes: overwhelming isolation and disconnection (devastating isolation of home dialysis; abandoned from support; escalating anxiety; compounding impact of feeling like a burden); importance of support systems (impact on relationships; need for emotional support; reassurance through shared experiences; valuing trustworthy and committed clinicians); burden of distress (individualised feelings of low mood; grappling with stigma surrounding diagnosis; contemplating treatment withdrawal and suicide); seeking mental health support (normalising mental health support as a distinct entity in dialysis care; overcoming barriers to seeking mental health support; additional tools for mental health support and connection)., Conclusion: Consumers may experience intense psychological distress during home-based dialysis care. Increasing clinician and health services literacy about the management of psychological impacts of home-based dialysis may improve consumer safety, quality of life and sustainability of home treatment., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article. RCW has previously received funding from Baxter Healthcare, Health Research Council and Lotteries Health New Zealand which do not pose a financial conflict of interest with respect to this work. SCP has received funding from Heath Research Council and Lotteries Health New Zealand, which does not pose a financial conflict of interest with respect to this work. The remaining authors declare that they have no relevant financial interests.

Objective: The aim of this study was to determine the psychological status of peritoneal dialysis (PD) patients who were blocked during the 2022 Omic Pandemic in Shanghai., Methods: This was an observational and cross-sectional study. We selected 172 PD patients from the peritoneal dialysis center of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, during the quarantine of the Omicron pandemic in Shanghai from April to May 2022. General data and biochemical indices were collected. The Kidney Disease Quality of Life (SF-36) questionnaire was used to evaluate the psychological state of the patients during the quarantine., Results: According to the assessment of the SF-36 scale, the physiological and psychological health status of PD patients was better than that before quarantine (P < 0.05). According to the comparison of biochemical indices, the high-density lipoprotein, total cholesterol and body mass index (BMI) levels were lower in patients after quarantine than before quarantine, while the blood phosphorus, blood calcium and haemoglobin levels were greater after quarantine (P < 0.05). Logistic regression analysis revealed that health changes were positively correlated with age of penetration (years) (OR = 1.031, 95% CI = 1.005-1.058); however, physiological function was negatively correlated with sex (OR = 0.198, 95% CI = 0.044-0.899). Energy was significantly positively correlated with closed-loop time (OR = 1.063, 95% CI = 1.001-1.128) (P < 0.05). There were no significant differences in biochemical indices or quality of life between APD patients and non-APD patients (P > 0.05). According to the results of the abstract independent sample T test, when comparing the various dimensions of the SF-36 scale, for the dimensions of physiological function, pain and energy, the PD patients were better than the HD patients were (P < 0.05). Similarly, for the dimension of physiological function, the HD patients were better than the PD patients were (P < 0.05). During the quarantine period from April to May in Shanghai, the infection rate of PD patients was lower than usual (P < 0.05)., Conclusions: During the Omicron pandemic in Shanghai in 2022, PD patients exhibited relatively stable psychological and physiological states and a low infection rate. Compared with HD patients, PD patients had better adaptability. Especially in the context of the COVID-19 pandemic, peritoneal dialysis has more advantages., (© 2024. The Author(s).)

Objective: The objective of this study was to examine the quality of life among peritoneal dialysis (PD) patients and identify the influencing factors., Methods: The study was conducted between March 2021 and December 2021 at the Peritoneal Dialysis Center of the Second Hospital affiliated with Harbin Medical University. A total of 148 patients with end-stage renal disease (ESRD) undergoing PD were included. Demographic information, assessments of dialysis adequacy, biochemical evaluations, and the administration of the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were carried out. The study analyzed the factors influencing the quality of life of these dialysis patients using the Spearman correlation coefficient and multiple linear regression., Results: The KDQOL-36 score for PD patients was 69.78±15.62, with 15.6% experiencing anxiety and 59.7% reporting depression. Age (r = -0.209), residual renal creatinine clearance rate (residual Ccr, r=-0.261), SAS (r=-0.623), and SDS (r = -0.116) scores exhibited significant negative correlations with KDQOL-36 scores (P < .05), while serum albumin levels (r = 0.199) showed significant positive correlations with KDQOL-36 scores (P < .05). Advanced age, poor nutritional status, low serum albumin levels, reduced residual renal Ccr, and high SAS and SDS scores were identified as significant predictors of lower KDQOL-36 scores (P < .05)., Conclusions: The psychological state, age, nutritional status, serum albumin levels, and residual renal function significantly impacted the quality of life of PD patients.

Background: Patients with end-stage renal disease undergoing haemodialysis experience a variety of stressors leading to decreased level of quality of life (QoL). Thus, in this study, we aimed to review the current literature and identify factors affecting the health-related QoL (HRQoL) in these patients., Methods: A total of 147 studies were extracted from databases of Web of Science, PubMed, Scopus, Google Scholar, and Embase published between January 2000 and December 2020. Data were analysed using R software and results were reported with reference to Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards., Results: A total of 623 728 patients undergoing dialysis participated in 147 studies in which QoL was assessed by means of two valid questionnaires, including Short-Form 36 (SF-36) and Kidney Disease Quality of Life (KDQOL)-short form V.1.3. Total HRQoL score for patients undergoing dialysis measured by KDQOL was 64.25 (95% CI 55.67 to 72.82). Based on SF-36, the mean score of mental health items was higher than the mean score of physical health condition. Furthermore, meta-regression based on the geographical place of residence revealed that the highest QoL in patients was observed in Japan, 66.96 (95% CI 63.65 to 70.28) and Brazil, 58.03 (95% CI 53.45 to 62.6)., Conclusion: Studies conducted on HRQoL among patients undergoing dialysis recommend useful strategies to clinicians, letting them assess patients' QoL in terms of a wide range of physical, mental and environmental aspects., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Hemodialysis (HD) and peritoneal dialysis (PD) treatments impact the economic burden and psychological distress faced by end-stage kidney disease (ESKD) patients and their caregivers. This review aimed to discuss the concept of an economic burden and the economic burden of different treatment options, and to highlight research gaps regarding the scarcity of previous studies relating economic burden to psychological well-being. We searched five electronic databases for papers published in 2010-2020. Papers focusing on measures of the economic burden from the government's perspective and diseases other than ESKD were excluded. Out of the 6635 publications identified, 10 publications were included. Three categories of economic burden were identified, namely, direct medical costs, direct non-medical costs, and indirect costs. Direct medical costs required the highest expenditure, whereas the lowest economic burden was for indirect costs. HD patients incurred a higher economic burden than PD patients. Most of the studies were carried out in Asia. The results of the research suggest that the economic burden may affect patients and caregivers, but it is unclear whether the economic burden affects the psychological well-being of the patients and caregivers. Very few studies have assessed the relationship between economic burden and psychological well-being, and further research is needed to gain further insight into the relationship between these two variables., (Copyright © 2023 Copyright: © 2023 Saudi Journal of Kidney Diseases and Transplantation.)

Hope is a goal-directed thought that reflects the sense of control over uncertainties and can promote adjustment to chronic illness. This study aimed to assess the level of hope among patients on peritoneal dialysis and evaluate the association of hope with health-related quality of life and psychological distress. This cross-sectional study included 134 Chinese patients receiving peritoneal dialysis in Hong Kong. Patients' level of hope was assessed using the Adult Trait Hope Scale. Participants who were employed, had a higher income, and received automated peritoneal dialysis reported a higher hope score. Hope was found to have significant correlations with age and social support. A higher hope score was associated with better mental well-being and less severe depressive symptoms. Specific relationships between agency/pathway thinking and these outcomes were identified. The patient subgroups at risk for losing hope need to be identified and received early interventions to prevent adverse outcomes., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Patients receiving peritoneal dialysis (PD) experience poor quality of life, depression, anxiety and lifestyle changes. Insights into how patients adjust to and cope with PD from a psychological perspective will aid care., Methods: Participants were recruited purposively through the Central Northern Adelaide Renal and Transplantation Service in South Australia. Ten patients receiving automated PD (APD) (5 females and 5 males) aged 31 to 77 years (M = 59.3) participated in a semi-structured interview. Interview transcripts were analysed thematically through inductive and deductive methods., Results: Five main themes representing participants' experiences and perspectives of adjusting to and coping with APD were identified: (1) Resigned Acceptance, (2) A Bridge to Transplant, (3) Navigating Emotions at Milestones and Transitions, (4) Professional Support (Sub-themes: Psychological Support and Education and Information Delivery and (5) Social Enablers (Sub-theme: Hidden from View and Hiding Illness)., Conclusions: Patients employ cognitive, emotional and behavioural strategies and rely strongly on social supports to cope with APD. PD at home aids preservation of pre-illness identity, however, also results in feelings of isolation and being misunderstood. Psychological distress and poor coping may be heightened at key disease milestones and transition periods when professional psychological support should be offered. We provide suggestions to address patients' psychosocial needs and coping in treatment decision-making and dialysis care.

BACKGROUND This study compared the effects of peritoneal dialysis and hemodialysis on cognitive dysfunction and health-related quality of life (HRQOL) in end-stage renal disease (ESRD) patients and analyzed other potential influencing factors. MATERIAL AND METHODS A total of 265 patients who received dialysis at our hospital were included and divided into the hemodialysis group (n=115) and the peritoneal dialysis group (n=150). The cognitive performance was assessed by the Beijing version of the Montreal Cognitive Assessment. The Kidney Disease Quality of 36-Item Short Form Survey and a kidney disease-related quality of life assessment were used for evaluating HRQOL. Univariate and multivariate linear regression analyses were used to explore the effects of dialysis on cognitive dysfunction and HRQOL. RESULTS As compared with the hemodialysis group, the peritoneal dialysis group had lower scores on the Montreal Cognitive Assessment (ß=-8.35, 95% CI: -9.85 to -6.86), 36-Item Short Form Survey (ß=-10.20, 95% CI: -11.94 to -8.45), and kidney disease-related quality of life assessment (ß=-8.67, 95% CI: -10.10 to -7.23). After adjustment for sex, age, BMI, marital status, educational level, income level, presence of diabetes, duration of kidney disease, duration of dialysis, and dialysis frequency, the results were consistent with that of the crude model. CONCLUSIONS In the present study, patients receiving peritoneal dialysis had worse cognitive dysfunction and worse HRQOL compared to patients receiving hemodialysis, which might lead to poorer outcomes of ESRD patients. The related factors affecting cognitive dysfunction and HRQOL were also explored, which could help clinicians to determine the optimal treatment for ESRD patients.

The severe acute respiratory syndrome coronavirus (SARS-Cov-2) resulting in the coronavirus disease 2019 (COVID-19) is documented to have a negative psychosocial impact on patients. Home dialysis patients may be at risk of additional isolating factors affecting their mental health. The aim of this study is to describe levels of anxiety and quality of life during the COVID-19 pandemic among home dialysis patients. This is a single-centre survey of home dialysis patients in Toronto, Ontario. Surveys were sent to 98 home haemodialysis and 43 peritoneal dialysis patients. Validated instruments (Haemodialysis and Peritoneal Dialysis Treatment Satisfaction Questionnaire, Generalized Anxiety Disorder 7 Item [GAD7] Scale, Patient Health Questionnaire [PHQ-9], Illness Intrusiveness Ratings Scale, Family APGAR Questionnaire and The Self Perceived Burden Scale) assessing well-being were used. Forty of the 141 patients surveyed, participated in September 2020. The mean age was 53.1 ± 12.1 years, with 60% male, and 85% home haemodialysis, 80% of patients rated their satisfaction with dialysis at 8/10 or greater, 82% of respondents reported either "not at all" or "for several days" indicating frequency of anxiety and depressive symptoms, 79% said their illness minimally or moderately impacted their life, 76% of respondents were almost always satisfied with interactions with family members, 91% were never or sometimes worried about caregiver burden. Among our respondents, there was no indication of a negative psychosocial impact from the pandemic, despite the increased social isolation. Our data further supports the use of home dialysis as the optimal form of dialysis., (© 2021 Asian Pacific Society of Nephrology.)

Introduction: There are many differences between hemodialysis (HD) and peritoneal dialysis (PD) treatments, including their impact on the psychological status of the patients. In this study, our aim was to compare the psychological statuses of HD and PD patients during the social isolation period due to the COVID-19 pandemic., Methods: We conducted this cross-sectional study on adult HD and PD patients when the curfew measures were in effect. We used an electronic form composed of 3 sections to collect data. In the first section, we collected data on the demographics and clinical and laboratory parameters of the patients. The second and third sections consisted of the Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale-Revised (IES-R) questionnaires, respectively., Results: The HD (n = 116) and PD (n = 130) groups were similar regarding age and sex, and they had similar HADS anxiety scores. HADS depression scores were higher in PD patients (p = 0.052). IES-R scores were significantly higher in PD patients in comparison to HD patients (p = 0.001). Frequencies of abnormal HADS-anxiety (p = 0.035) and severe psychological impact (p = 0.001) were significantly higher in PD patients., Discussion/conclusion: During the social isolation period due to the COVID-19 pandemic, HD patients had better mood profiles than PD patients. A more stable daily routine, an uninterrupted face-to-face contact with health-care workers, and social support among patients in the in-center dialysis environment might be the cause of the favorable mood status. PD patients might need additional psychological support during those periods., (© 2021 S. Karger AG, Basel.)

Background: Health-related quality of life (HRQoL) is an important predictor of health outcomes in chronic kidney disease (CKD) including those patients in renal replacement therapy. Its evaluation through validated questionnaires is essential for comprehensive care in people undergoing renal replacement therapy., Aim: To evaluate the quality of life in patients with CKD on peritoneal dialysis., Material and Methods: Descriptive cross-sectional study. The KDQOL-36 quality of life questionnaire was applied to 67 patients aged 55 ± 15 years, in peritoneal dialysis at a public hospital in Santiago. Scores range from 0 to 100, values greater than 50 represent a better HRQoL., Results: The burden, symptoms, and effects of kidney disease component of the survey had scores over 50. Women, people without diabetes, those actively working and those with better incomes reported a better HRQoL., Conclusions: These patients on peritoneal dialysis report a good quality of life, especially in the specific components of kidney disease.

Background: Sleep disturbance is a prominent concern in dialysis patients and detrimentally impacts clinical and self-reported health outcomes. This study aimed to collect sleep data from in-home actigraphy and to explore possible predictors of sleep quality in older peritoneal dialysis patients., Methods: This was a cross-sectional study. Peritoneal dialysis patients aged ≥60 years participated in this study. For each participant, sleep quality was assessed by analyzing the data produced by an actigraphic device worn on the wrist 24 h a day for seven consecutive days. Physical function was assessed using handgrip strength and the Timed Up and Go test. Depression was assessed using the self-reported Geriatric Depression Scale. Multiple linear regression analyses were performed to examine the factors influencing sleep efficiency and sleep time., Results: Based on data collected from 50 participants ( N  = 50, mean age 70.4 years, 70% male), including 333 nights of actigraphy-monitored sleep, the mean sleep efficiency was 75.5%±14.2% and the mean total sleep time 391.0 ± 99.3 min per night. Higher hemoglobin (β = 0.38, p  = 0.007) and lower serum phosphorus (β = -0.30, p  = 0.042) levels were significant predictors of better sleep efficiency. The only significant predictor of the total sleep time was age (β = 0.32, p  = 0.021)., Conclusion: Older peritoneal dialysis patients had poor sleep, characterized by low sleep efficiency. Low hemoglobin and high serum phosphorus levels were predictors of poor sleep efficiency and, as such, modifiable factors for clinicians to consider when treating patients with sleep complaints.

Rationale & Objective: Individuals faced with decisions regarding kidney replacement therapy options need information on how dialysis treatments might affect daily activities and quality of life, and what factors might influence the evolution over time of the impact of dialysis on daily activities and quality of life., Study Design: Observational cohort study., Setting & Participants: 7,771 hemodialysis (HD) and peritoneal dialysis (PD) participants from 6 countries participating in the Peritoneal and Dialysis Outcomes and Practice Patterns Studies (PDOPPS/DOPPS)., Predictors: Patient-reported functional status (based on daily living activities), country, demographic and clinical characteristics, and comorbidities., Outcome: Employment status and patient-reported outcomes (PROs) including Kidney Disease Quality of Life (KDQOL) instrument physical and mental component summary scores (PCS, MCS), kidney disease burden score, and depression symptoms (Center for Epidemiologic Studies Depression Scale [CES-D] score > 10)., Analytical Approach: Linear regression (PCS, MCS, kidney disease burden score), logistic regression (depression symptoms), adjusted for predictors plus 12 additional comorbidities., Results: In both dialysis modalities, patients in Japan had the highest PCS and employment (55% for HD and 68% for PD), whereas those in the United States had the highest MCS score, lowest kidney disease burden, and lowest employment (20% in HD and 42% in PD). After covariate adjustment, the association of age, sex, dialysis vintage, diabetes, and functional status with PROs was similar in both modalities, with women having lower PCS and kidney disease burden scores. Lower functional status (score <11) was strongly associated with lower PCS and MCS scores, a much greater burden of kidney disease, and greater likelihood of depression symptoms (CES-D, >10). The median change in KDQOL-based PROs was negligible over 1 year in participants who completed at least 2 annual questionnaires., Limitations: Selection bias due to incomplete survey responses. Generalizability was limited to the dialysis populations of the included countries., Conclusions: Variation exists in quality of life, burden of kidney disease, and depression across countries but did not appreciably change over time. Functional status remained one of the strongest predictors of all PROs. Routine assessment of functional status may provide valuable insights for patients and providers in anticipating outcomes and support needs for patients receiving either PD or HD., (Copyright © 2021. Published by Elsevier Inc.)

Introduction: Many studies have explored patients' experiences of dialysis and other treatments for kidney failure. This is the first qualitative multi-site international study of how staff perceive the process of a patient's transition from peritoneal dialysis to in-centre haemodialysis. Current literature suggests that transitions are poorly coordinated and may result in increased patient morbidity and mortality. This study aimed to understand staff perspectives of transition and to identify areas where clinical practice could be improved., Methods: Sixty-one participants (24 UK and 37 Australia), representing a cross-section of kidney care staff, took part in seven focus groups and sixteen interviews. Data were analysed inductively and findings were synthesised across the two countries., Results: For staff, good clinical practice included: effective communication with patients, well planned care pathways and continuity of care. However, staff felt that how they communicated with patients about the treatment journey could be improved. Staff worried they inadvertently made patients fear haemodialysis when trying to explain to them why going onto peritoneal dialysis first is a good option. Despite staff efforts to make transitions smooth, good continuity of care between modalities was only reported in some of the Australian hospitals where, unlike the UK, patients kept the same consultant. Timely access to an appropriate service, such as a psychologist or social worker, was not always available when staff felt it would be beneficial for the patient. Staff were aware of a disparity in access to kidney care and other healthcare professional services between some patient groups, especially those living in remote areas. This was often put down to the lack of funding and capacity within each hospital., Conclusions: This research found that continuity of care between modalities was valued by staff but did not always happen. It also highlighted a number of areas for consideration when developing ways to improve care and provide appropriate support to patients as they transition from peritoneal dialysis to in-centre haemodialysis., Competing Interests: The authors have declared that no competing interests exist.

Background: There is no published meta-analysis comparing the effects of dialysis modality choice on cognitive functions in patients with end-stage renal disease . Therefore, we perform a protocol for systematic review and meta-analysis to evaluate cognitive function in peritoneal dialysis versus hemodialysis patients., Methods: This protocol is conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P) statement guidelines. Related articles were identified by searching Web of Science, Embase, PubMed, Wanfang Data, Medline, Science Direct, and Cochrane Library. The risk of bias assessment of the included articles was performed by two authors independently using the tool recommended in the Cochrane Handbook for Systematic Reviews of Interventions. All calculations were carried out with Stata 11.0 (The Cochrane Collaboration, Oxford, United Kingdom)., Results: The results of this systematic review and meta-analysis will be published in a peer-reviewed journal., Conclusion: We hypothesized that patients on peritoneal dialysis demonstrated a lower odd of cognitive dysfunction compared to those on hemodialysis., Open Science Framework Registration Number: 10.17605/OSF.IO/NWCZK., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: Despite the advancements in renal replacement therapy, patients with end-stage renal disease face several limitations, with significant impacts on health-related quality of life (HRQoL) and mortality. This study aims to examine associations between quality of life and risk of death in Brazilian patients who underwent dialysis therapy between 2007 and 2015., Methods: Observational, prospective, non-concurrent cohort study of patients who underwent dialysis therapy at the Brazilian Public Health System (SUS) and were followed up for 8 years. Semi-structured questionnaires interrogating socioeconomic and demographic characteristics, as well as HRQoL measures (36 Item Short-Form Health Survey, SF-36), were employed. The Cox proportional risk model was used to investigate associations between HRQoL and risk of death., Results: Our sample comprised 1162 patients; of these, 884 were on hemodialysis (HD) and 278 on peritoneal dialysis (PD). Among the HD patients, death was associated with the physical (HR: 0.993; 95% CI: 0.989-0.997) and physical summary component (HR: 0.994; 95% CI: 0.989-0.999) domains of HRQoL. Regarding the PD patients, death was associated with the bodily pain (HR: 0.994; 95% CI: 0.990-0.998), mental health (HR: 0.094; 95% CI: 0.990-0.998), emotional problems (HR: 0.993; 95% CI: 0.987-0.998), social functioning (HR: 1.012; 95% CI: 1.002-1.023), physical problems (HR: 0.992; 95% CI: 0.986-0.998) and mental summary component (HR: 0.989; 95% CI: 0.981-0.997) domains of HRQoL., Conclusions: Our data suggest that early and timely intervention measures aiming to enhance the HRQoL of dialysis patients are an essential component of professional practice and may contribute to improving the management of factors associated with dialysis patients' mortality.

Background: Although most patients are suitable for both hemodialysis (HD) and peritoneal dialysis (PD), there seem to be differences in the outlook of patients who choose one modality over the other. There is currently limited literature about the impact of patients' personal attitudes on the decision for PD or HD. In this study, we tried to find out whether there were differences between patients who were on HD and PD in their desire for control and responsibility for their treatment., Methods: The data were drawn from a nationwide postal survey of 630 HD and PD patients. Patients' desire for control was measured by scores on the internal locus of control (ILOC) scale. Patients were also asked how important taking responsibility for their dialysis had been for their treatment decision (ITR). Two multivariate logistic regression models, both adjusted for age, were applied to investigate whether there were differences between HD and PD patients in ILOC and ITR. Having one generic measure (ILOC) and one tailored to the dialysis context (ITR) gave the opportunity to investigate if it is a generic personality trait or rather a specific attitude that affects choice of dialysis modality., Results: PD patients were younger and showed higher ILOC and ITR values. Multivariate logistic regression models adjusted for age confirmed the significant influence of ILOC and ITR on the uptake of PD. The odds ratios for being in the PD group were 1.53 for ILOC (p = 0.030; 95% CI 1.04-2.25), 1.49 for ITR (p = 0.019; 95% CI 1.07-2.07), and 0.95 (p = 0.000; 95% CI 0.94-0.97) for age in both models., Conclusions: Our analysis shows the impact of personal attitudes on the uptake of PD. Participants who generally want to keep control of their lives and take responsibility for their dialysis treatment tended to choose PD. As PD is a home dialysis treatment that requires patients to participate and contribute, it is beneficial if patients' personalities support the treatment procedure. Having two completely different treatment options that suit to different personalities gives us the opportunity to consider the relationship between personal attitudes and choice of dialysis modality., Trial Registration: The MAU-PD study is registered at the German Clinical Trials Register., Drks-Id: DRKS00012555 . Date of Registration in DRKS: 2018/01/04.

Background: The low prevalence of peritoneal dialysis (PD) (9%) vs. hemodialysis (HD) (88.2%) is partly due to patient dropout from therapy., Methods: This retrospective study identified patients who withdrew from PD between 2016 and 2018 in our program. We evaluated all other factors as controllable losses. Analysis included time on therapy at dropout (very early, early or late) and method of initiation (HD to PD conversion, unplanned PD, or planned start)., Results: Eighty-three patients enrolled into our PD program. 27 dropped out; 24 were due to controllable factors, 3 due to death, with a median age at dropout of 52 years old. We determined psychosocial factors (PF) to be the largest controllable factor influencing dropout; contributing a 63% rate among all controllable factors. When considering time until dropout, 100% of very early dropout patients and 50% of late dropout patients did so due to PF. Among early dropout patients 67% dropped out due to other medical reasons. The mean time to dropout for PF, other, and infection (INF) were 13, 26, and 33 months, respectively. When considering type of initiation, we found PF to be the largest attributable factor with 50% of unplanned, 100% of planned, and 50% of conversions stopping therapy., Conclusions: Our study indicates that the primary reason for controllable loss from therapy was secondary to PF regardless of the time on therapy or the method of initiation to therapy., (Copyright © 2020 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)

Background: Since the outbreak of COVID-19 in December 2019, it has spread rapidly and widely, bringing great psychological pressure to the public. In order to prevent the epidemic, traffic lockdown was required in many areas of China, which led to inconvenience of treatment for dialysis patients. This study was conducted to explore the psychological distress and the psychological demand induced by CO-VID-19 in the patients undergoing dialysis and compare the difference between hemodialysis (HD) and peritoneal dialysis (PD) patients during the traffic lockdown period., Methods: Questionnaires were given to the dialysis patients in the West China Hospital of Sichuan University. The Impact of Event Scale (IES) was used to investigate the patients' trauma-related distress in response to COVID-19., Results: 232 eligible respondents were enrolled in this cross-section study, consisting of 156 PD patients and 76 HD patients. The median IES score for all the enrolled patients was 8.00 (2.00-19.00), which belonged to the subclinical dimension of post-traumatic stress symptoms (PTSS). HD patients had a significant higher IES score than PD patients (11.50 vs. 8.00) (p < 0.05). HD patients already got more psychological support from the medical staff. According to IES scores, 22.4% HD patients and 13.4% PD patients were classified as having moderate or severe PTSS, which need psychological support (p < 0.05). But more patients of both groups considered psychological support was necessary (HD: 50%, PD: 45.5%) (p > 0.05). In the multivariate regression analysis, we found that dialysis vintage, the impact of COVID-19 on the severity of illness and daily life, and confidence in overcoming the disease contributed to IES score (p < 0.05)., Conclusions: HD patients had more severe trauma-related stress symptoms than PD patients. When major public healthy events occurred, careful psychological estimate and sufficient psychological support should be provided to the dialysis patients, especially to the HD patients., (© 2020 S. Karger AG, Basel.)

Background: Most elderly people undergoing peritoneal dialysis (PD) treatment have a high incidence of frailty, cognitive impairment and emotional disturbance leading to a significant impact on families. The burden experienced by the family caregivers could affect their physical and emotion health. The objective of this study was to examine the level of burden on family caregivers of elderly adults receiving PD and to identify any contributing factors., Materials and Methods: This was a cross-sectional study employing convenience sampling. Patient-caregiver dyads were recruited from the outpatient clinic of a university hospital in China in 2019. Caregivers provided information on their perceived burden and health-related quality of life. The elderly patients reported their functional dependence and depressive symptoms in the same interview. Linear regression analyses were used to determine the factors contributing to caregivers' burden., Results: Sixty patient-caregiver dyads were recruited. The patients had a mean age of 70.7 ± 7.4 years. The caregivers reported moderate levels of burden having ZBI score of 30.5 ± 15.9. Multivariate analyses showed that being female, perceiving one's financial status as insufficient, a low level of social support for the caregiver, depressive symptoms in the patients and disability in carrying out the instrumental activities of daily life were statistically significant predictors of caregiver burden (adjusted R 2  = 0.46, p < 0.001)., Conclusion: Elderly adults receiving PD who experience physical dependence and depressive symptoms are a burden for caregivers. In response to this challenge, interventions designed with the goal of supporting the emotional and mental wellbeing of caregivers are warranted., (© 2020 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

Objective: The study aimed to explore the best follow-up management strategy for patients undergoing peritoneal dialysis (PD) during the novel coronavirus pneumonia (NCP) epidemic., Patients and Methods: Patients undergoing PD who were followed up during the NCP epidemic by our hospital were enrolled in this study. Because of the need to control the epidemic, a follow-up system was established during the epidemic period, with WeChat, QQ, and the telephone as the main methods of communication. Outpatient and emergency follow-ups were carried out to ensure the safety of dialysis and the prevention and control of the epidemic. The follow-up strategy included response measures related to the epidemic situation, prevention of peritonitis related to PD, water and salt control, exercise guidance, and psychological care. According to the patient's condition, the appointment system was implemented, with one consulting room and one process for each patient. The emergency patients were isolated in accordance with the epidemic situation., Results: Since January 2020, among the 580 patients undergoing PD who were followed up in our department and their families, none had NCP infection. During the epidemic period, the standard hemoglobin level and the inpatient rate decreased. Complications related to PD, such as peritonitis, cardiovascular complications caused by volume overload, and pulmonary infection, did not significantly increase, and the withdrawal rate and mortality rate decreased compared with those in the same period last year., Conclusions: The patient follow-up strategy during the epidemic period had a significant positive effect on preventing and controlling the epidemic. Furthermore, during the epidemic period, encouraging patients and caregivers to pay attention to protection at home, avoid going out, strengthen self-management, and other measures were beneficial to the control of kidney disease itself, which is worth promoting. The close relationship between doctors and patients during the epidemic had a positive effect on the occurrence of complications related to patients undergoing PD.

Background: While peritoneal dialysis (PD) can offer patients more independence and flexibility compared with in-center hemodialysis, managing the ongoing and technically demanding regimen can impose a burden on patients and caregivers. Patient empowerment can strengthen capacity for self-management and improve treatment outcomes. We aimed to describe patients' and caregivers' perspectives on the meaning and role of patient empowerment in PD., Methods: Adult patients receiving PD (n = 81) and their caregivers (n = 45), purposively sampled from nine dialysis units in Australia, Hong Kong and the USA, participated in 14 focus groups. Transcripts were thematically analyzed., Results: We identified six themes: lacking clarity for self-management (limited understanding of rationale behind necessary restrictions, muddled by conflicting information); PD regimen restricting flexibility and freedom (burden in budgeting time, confined to be close to home); strength with supportive relationships (gaining reassurance with practical assistance, comforted by considerate health professionals, supported by family and friends); defying constraints (reclaiming the day, undeterred by treatment, refusing to be defined by illness); regaining lost vitality (enabling physical functioning, restoring energy for life participation); and personal growth through adjustment (building resilience and enabling positive outlook, accepting the dialysis regimen)., Conclusions: Understanding the rationale behind lifestyle restrictions, practical assistance and family support in managing PD promoted patient empowerment, whereas being constrained in time and capacity for life participation outside the home undermined it. Education, counseling and strategies to minimize the disruption and burden of PD may enhance satisfaction and outcomes in patients requiring PD., (© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)

Background: To describe the associated factors for non-medical reasons for dropout in peritoneal dialysis (PD) patients., Methods: A retrospective cohort study was performed using registry data of adult patients commencing PD as their initial renal replacement therapy in one hospital-facilitated PD center in Taiwan between 2014 and 2018. The collected data included socio-demographics and relevant medical and PD-related parameters. Kaplan-Meier analysis was used to determine the impact of non-medical reasons and medical reasons on PD dropout., Results: The analysis included 224 PD patients, of whom 37 dropped out for non-medical reasons and 187 for medical reasons during the study period. There was significant difference between the two cohorts in age (62.3 years vs. 56.1 years, P = 0.010) and PD vintage (median 3.4 years vs. 4.8 years, P = 0.001). Diabetes was more predominant in the cohort for non-medical reasons than in the one for medical reasons (54.1% vs. 27.3% respectively, P = 0.001). In non-medical reason cohort, two leading reasons given for dropping out were lacking of caregivers (n = 12) and losing confidence (n = 10), whereas PD-related peritonitis (n = 101) was the main medical reason for PD dropout. Using Kaplan-Meier curve analysis, patients in the non-medical reason cohort demonstrated higher cumulative dropout rate compared to patients in the medical reason cohort during a 10-year period (P < 0.001)., Conclusions: The main characteristics of PD dropout patients for non-medical reasons are age, diabetes, patients' perception and caregiver support.

Cardiovascular disease-associated morbidity and mortality are reportedly higher in hemodialysis (HD) patients compared with peritoneal dialysis (PD) patients. However, few studies have estimated changes in state of depression and cognitive impairment in patients undergoing HD and PD. The present study evaluated the impact of HD or PD on patients' quality of life (QoL), cognitive impairment, and depression status over 2 years. This 24-month observational, prospective study included 45 HD and 30 PD patients. Patients were assessed before and every 12 months after starting dialysis for 24 months. Measurements included QoL (36-Item Short-Form Health Survey [SF-36]), cognitive impairment (Mini-Mental State Examination [MMSE]), depressive state (Center for Epidemiologic Studies Depression Scale [CES-D]), grip strength, and 24-h urine volume (UV). Physical and social component scores of the SF-36 significantly improved in PD patients at 24 months compared with those observed at baseline (42.8 vs. 39.4; P < 0.05 and 46.4 vs. 37.3; P < 0.05, respectively); however, scores remained unchanged in HD patients. MMSE scores were significantly decreased at 12 and 24 months in HD patients (29.0 vs. 26.0, 25.0; P < 0.05), but remained unchanged in PD patients. Moreover, CES-D scores significantly worsened at 24 months in HD patients (12.8 vs. 16.5), but remained unchanged in PD. Preservation of UV and grip strength was associated with SF-36, CES-D, and MMSE scores. Our findings indicate that PD is associated with higher QoL and recovery from cognitive failure compared with HD., (© 2019 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.)

Objective: End-stage renal disease (ESRD) leads to renal replacement therapy and certainly has an impact on patients' health-related quality of life (HRQoL). This study aimed to review and compare the HRQoL between peritoneal dialysis (PD) and hemodialysis (HD) patients using the 36-Item Short Form Health Survey (SF-36), EuroQoL-5-dimension (EQ-5D) and the Kidney Disease Quality of Life Instrument (KDQOL)., Methodology: Systematic review was conducted by identify relevant studies through MEDLINE and SCOPUS up to April 2017. Studies were eligible with following criteria: studied in ESRD patients, compare any pair of renal replacement modalities, and reported HRQoL. The unstandardized mean differences (USMD) of HRQoL among modalities were calculated and pooled using a random-effect models if heterogeneity was present, otherwise a fixed-effect model was applied., Results: A total of twenty-one studies were included with 29,000 participants. Of them, mean age and percent male were 48.1 years and 45.1, respectively. The pooled USMD (95% CI) of SF-36 between PD and HD (base) were 1.86 (0.47, 3.24) and 0.42 (- 1.99, 2.82) for mental component and physical component summary scores, respectively. For EQ-5D, the pooled USMD of utility and visual analogue scale (VAS) score were 0.02 (- 0.06, 0.10) and 3.56 (1.73, 5.39), respectively. The pooled USMD of KDQOL were 9.67 (5.67, 13.68), 6.71 (- 5.92, 19.32) 6.30 (- 0.41, 12.18), 2.35 (- 4.35, 9.04), 2.10 (0.07, 4.13), and 1.21 (- 2.98, 5.40) for burden of kidney disease, work status, effects of kidney disease, quality of social interaction, symptoms, and cognitive function., Conclusion: Patients with chronic kidney disease (CKD) stage 5 or ESRD treated with PD had better generic HRQoL measured by SF-36 and EQ-5D than HD patients. In addition, PD had higher specific HRQoL by KDQOL than HD patients in subdomain of physical functioning, role limitations due to emotional problems, effects and burden of kidney disease.

Background: Individuals receiving peritoneal dialysis (PD) report low levels of physical activity, which increases their risk of morbidity and mortality. Little is known about their perceptions towards barriers and benefits of exercise or physical activity., Aim: The aim of this study was to explore the perceptions of exercise among people receiving PD., Study Design: Cross-sectional survey., Participants: Thirty-nine adults (12 female and 27 male) with a mean age of 65 years and a median of 8 months receiving PD from one Australian dialysis service., Measurements: The 26-item Dialysis Patient-Perceived Exercise Benefits and Barriers Survey was adapted to PD in order to measure self-reported barriers and benefits of exercise for people being treated with PD., Results: The majority of the respondents reported positive perceptions towards exercise with 84.6% of the participants agreeing that exercise prevents muscular wasting; 71.8% agreed that exercise can postpone a decline in body function; and 69.2% agreed that exercise improves general well-being. In terms of barriers, symptoms including tiredness (69.2%) and body pain (43.6%), worrying about a fall (33.3%) and lack of exercise-related information (25.6%) were the main perceived barriers to exercise. Only 10% agreed that exercise may affect their PD catheter with 23% agreeing that fluid in their peritoneum was a barrier to exercise., Conclusion: People on PD hold positive perceptions towards exercise but face a number of perceived barriers to physical activity. Clinicians can acknowledge these barriers and focus on helping people on PD to overcome their perceived barriers to encourage sustained exercise participation., (© 2020 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

Purpose: The waiting list period for kidney transplantation can be lengthy and associated with a deteriorated health-related quality of life (HRQoL). It might also be experienced differently depending on the experience of renal replacement therapy (preemptive or dialyzed patients), and the type of dialysis. The main objective of this study is to measure and compare HRQoL changes in preemptive, hemodialysis (HD), and peritoneal dialysis (PD) patients during the waiting list period for kidney transplantation., Methods: A sample of adult patients on kidney transplant waiting list from three French University Hospital centers was recruited. HRQoL was measured using the SF-36 and a specific questionnaire (ReTransQol), which were collected every 6 months before transplantation in preemptive, HD, and PD patients. Mixed-effects models taking into account time and possible confounding factors were used to compare HRQoL changes between the three groups., Results: Preemptive (n = 230), HD (n = 177), and PD patients (n = 39) were enrolled. The renal replacement therapy modalities, time (time on waiting list and age at registration), and gender were associated with HRQoL changes. The HD and PD patients had a significantly lower perceived HRQoL on Role Physical, Social Functioning, and Role Emotional dimensions than the preemptive patients, with lower scores for PD compared to HD patients. The HRQoL scores of all patients were lower compared to the French general population for all dimensions., Conclusions: A better understanding of pre-transplantation patients' experience can help improving patient care with adapted educational programs and psychological support depending on the type of renal replacement therapy.

Resilience is a potential human psycho-social ability that can reduce negative emotion and promote adaptation to adversity. Most previous studies on resilience have highlighted positive factors for patients with chronic illnesses; however, very few focus on the resilience of patients undergoing peritoneal dialysis (PD) using a qualitative approach. Using Q-methodology, we identified the perceptions of resilience of patients undergoing PD. We recruited 33 Korean participants undergoing PD in a university hospital, and classified 37 Q-samples into a 9-point normal distribution grid. Collected data were analyzed using the PC-QUANL program. The perceived subjectivity of the resilience of Korean patients undergoing PD was categorized as three factors: "support-based acceptance," "gloomy isolation," and "active life-oriented." The three factors explained 47.4% of the total variance. The eigenvalues were 9.99, 3.40, and 2.26, respectively. These findings suggest that a differentiated approach is needed for interventions to enhance the resilience of patients undergoing PD. This study highlights that clinical nurses and health professionals should understand the perceptions of resilience of patients undergoing PD, and consider their viewpoints in the caring and treatment process., (© 2019 John Wiley & Sons Australia, Ltd.)

Introduction: Peritoneal dialysis (PD) provides a safe, home-based continuous renal replacement therapy for patients. The adherence of the patients to the prescribed dialysis fluids cannot always be monitored by physicians. Remote monitoring automated peritoneal dialysis (RM-APD) can affect patients' compliance with treatment and, thus, clinical outcomes., Objective: We aimed to evaluate the clinical outcomes of patients with a remote access program., Methods: This was an observational study. We analyzed the effect of RM-APD on treatment adherence, dialysis adequacy, and change in blood pressure control, sleep quality, and health-related quality of life during the 6 months of follow-up., Results: A total of 15 patients were enrolled in this study. It was found that there was a significant decrease (99 ± 19 vs. 89 ± 11 mm Hg) in mean arterial blood pressure of patients, and a considerable increase in Kt/V was observed in the sixth month after the RM-APD switch (2.11 ± 0.4 vs. 2.25 ± 0.5). A significant increase was found when comparing the 3-month and 6-month ultrafiltration amounts before RM-APD and the ultrafiltration amount within 6 months after RM-APD (800 mL [500-1,000] and 752 mL [490-986] vs. 824 mL [537-1,183]). The daily antihypertensive pill need (4 [0-7] vs. 2 [0-6]) and alarms received from the device decreased (from 4 [3-8] to 2 [0-3]) at the sixth month of the switch. There was no significant change in sleep quality and health-related quality of life within 6 months., Conclusion: This study showed that treatment adherence and ultrafiltration amounts of patients increased with the use of RM-APD, as well as better blood pressure control with fewer antihypertensive drugs., (© 2020 S. Karger AG, Basel.)

Background: End-stage renal disease (ESRD) is increasing both globally and in Asia. Singapore has the fifth highest incidence of ESRD worldwide, a trend that is predicted to rise. Older patients with ESRD are faced with a choice of haemodialysis, peritoneal dialysis or conservative management, all of which have their risks and benefits., Objective: This study seeks to explore perspectives on decision making amongst older (≥70) Singaporean ESRD patients and their caregivers to undergo (or not to undergo) dialysis., Design: Qualitative study design using semi-structured interviews., Setting and Participants: Twenty-three participants were recruited from the largest tertiary hospital in Singapore: seven peritoneal dialysis patients, five haemodialysis patients, four patients on conservative management and seven caregivers., Results: While some patients believed that they had made an independent treatment decision, others reported feeling like they had no choice in the matter or that they were strongly persuaded by their doctors and/or family members to undergo dialysis. Patients reported decision-making factors including loss of autonomy in daily life, financial burden (on themselves or on their families), caregiving burden, alternative medicine, symptoms and disease progression. Caregivers also reported concerns about financial and caregiving burden., Discussion and Conclusion: This study has identified several factors that should be considered in the design and implementation of decision aids to help older ESRD patients in Singapore make informed treatment decisions, including patients' and caregivers' decision-making factors as well as the relational dynamics between patients, caregivers and doctors., (© 2019 The Authors Health Expectations published by John Wiley & Sons Ltd.)

Background: Cognitive impairment (CI) is common among patients on peritoneal dialysis (PD), but it is under-recognized and systematic review on its prevalence and impact across different geographical locations or patient characteristics is lacking., Methods: A search of the literature on CI in PD patients published between 1 Jan 1980 and 25 . April 2019 was conducted. Meta-analysis using a random effects model was performed to determine the pooled estimate of the prevalence of CI. Meta-regression was performed to identify factors contributing to the variance of prevalence rate. A systematic review was also performed to study risk factors of CI and its impact on clinical outcomes., Results: Eight studies were included and the relevant data from 1736 patients were extracted for analysis. Meta-analysis revealed a pooled prevalence of CI at 28.7% (95% CI 15.9-46%). Meta-regression analyses showed that the prevalence of CI was unrelated to patient's age, gender, duration of PD, healthcare policy of dialysis modality, the prospective or retrospective nature of studies, or year of publication. Systematic review of 20 studies showed that older age, female sex and lower education were risk factors for CI. Potential reversible factors for CI include electrolytes disturbances, depression and vitamin D deficiency. Also, CI was associated with a higher risk of hospitalization, mostly due to PD-related peritonitis., Conclusions: CI is common in patients on long-term PD. Screening for CI should be considered in PD patients with increased risk.

Objective: Depression in dialysis patients is often undetected despite associations with poor outcomes. The aim was to determine the prevalence and associations of depressive symptoms and physician recognition of depression within a typical Australian dialysis population., Method: A cross-sectional study examined haemodialysis and peritoneal dialysis patients of two hospitals in Sydney. Participants were screened for depression using the Hospital Anxiety and Depression Scale (HADS)., Results: One hundred and ten patients completed the HADS. Subjects had a mean age of 63.7 years, 37% from a culturally and linguistically diverse background, and median dialysis duration of 2 years. Forty-one per cent of participants had significant depressive symptoms, of whom 42% had been diagnosed with depression by their clinicians. After adjustment for sociodemographic factors, having >10 medications prescribed, >3 hospitalisations in the last 12 months, and a history of depression were associated with depression., Conclusion: Depressive symptoms are prevalent in Australian dialysis patients. Robust evidence is needed on the effectiveness of treatments for depression in changing outcomes in chronic kidney disease.

Background: Depression has been recognized as a risk factor for cognitive impairment (CI) from cross-sectional datasets. This multicenter prospective study investigated the association between depression and cognitive decline in peritoneal dialysis (PD) patients. Methods: This multicenter prospective cohort study included 458 PD patients who were followed up for 2 years. The Modified Mini-Mental State Examination (3MS) was used for assessment of global cognitive function, Trail-Making Tests A and B for executive function, subtests of the Battery for the Assessment of Neuropsychological Status for immediate and delayed memory, visuospatial skill, and language ability. Depression was assessed using Zung's Self-Rating Depression Scale. Results: During the 2-year follow-up, patients with moderate/severe depression at baseline showed a significant decline in global cognitive function (80.5 ± 15.2 vs 76.6 ± 15.5, p = 0.008), while patients without depression or with mild depression kept a stable global cognitive function. In the meantime, patients without depression showed significant improvements in immediate memory, visuospatial skill, and language ability. However, no significant improvement in these parameters was shown in depression groups. In multivariable linear regression analysis, depression at baseline was a significant predictor of worsening global cognitive function, whether depression was analyzed as a continuous variable (odds ratio [OR] = -0.14, 95% confidence interval [CI] -0.27, -0.01, p = 0.031) or a rank variable (OR = -1.88, 95% CI -3.30, -0.45, p = 0.010). Moreover, higher depression score or more severe depression degradation was significantly associated with decline of immediate memory, delayed memory, and language skill. Conclusion: Depression was a significant risk factor for worsening of CI in PD patients., (Copyright © 2019 International Society for Peritoneal Dialysis.)

Background: People with end-stage kidney disease (ESKD) receiving peritoneal dialysis (PD) have been found to alter their adherence to the renal therapeutic regimen following their initial teaching by PD nurses. Since alterations of adherence have been associated with poor health outcomes, this study focuses on persons receiving PD who rely on support and re-education from their nurses., Objectives: To explore the teaching-learning partnership between people receiving PD and PD nurses, and to compare and contrast shared perspectives., Design: The study consisted of individual semi-structured interviews of four people receiving PD and three PD nurses, using qualitative content analysis., Findings: Four shared themes and nine sub-themes emerged: "motivation" was characterised by perceptions of "staying healthy to avoid peritonitis pain and to qualify for a transplant". One sub-theme emerged exclusively in the interviewed people receiving PD: "motivation" to initiate PD through "finding meaning in life and situation". The theme "acceptance" was comprised "of diagnosis and choosing to initiate PD" and the "modification and integration into daily life". The presence of "support" arose from "personal support from family and friends", "professional care and understanding of the individual" and "professional customised and re-iterative education". The evolving "partnership" was comprised of "exposure", "personal rapport", and the "necessity of working together" in order to maintain positive health outcomes., Conclusion: The partnership between the PD nurse and people receiving PD for ESKD is crucial for successful health outcomes. Each partnership is unique and evolves over time. A successful partnership requires nurses to modify the educational content and teaching style to best meet the needs of people receiving PD and, most importantly, allow them to feel cared for and supported., (© 2019 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

This study aimed to compare health-related quality of life (HRQOL) over time in patients initiating hemodialysis (HD) or peritoneal dialysis (PD). A total of 989 incident patients starting HD or PD were included from a prospective nationwide cohort study. HRQOL was assessed 3, 12, and 24 months after the start of dialysis. The scores of questionnaires were adjusted for clinical and socioeconomic parameters. The adjusted three months scores of patients on PD showed better HRQOL in eight end-stage renal disease (ESRD), three physical component summary and one mental component summary domains compared with patients on HD. Both patients on HD and PD experienced significant decreases in different HRQOL domains over two years and the degree of changes in HRQOL over time was not different between dialysis modality. However, the scores of three (effects of kidney disease, burden of kidney disease, and dialysis staff encouragement, all P < 0.05) and two (sexual function and dialysis staff encouragement, all P < 0.05) ESRD domains were still higher in patients on PD compared with patients on HD at one and two years after initiation of dialysis, respectively. PD shows better HRQOL during the initial period after dialysis even after adjusting for clinical and socioeconomic characteristics, and the effect lasts up to two years. It was similar in terms of changes in HRQOL over time between HD and PD.

In many countries, the use of peritoneal dialysis (PD) remains low despite arguments that support its greater use, including dialysis treatment away from hospital settings, avoidance of central venous catheters, and potential health economic advantages. Training patients to manage aspects of their own care has the potential to enhance health literacy and increase patient involvement, independence, quality of life, and cost-effectiveness of care. Complex reasons underlie the variable use of PD across the world, acting at the level of the patient, the health care team that is responsible for them, and the health care system that they find themselves in. Important among these is the availability of competitively priced dialysis fluid. A number of key interventions can affect the uptake of PD. These include high-quality patient education around dialysis modality choice, timely and successful catheter placement, satisfactory patient training, and continued support that is tailored for specific needs, for example, when people present late requiring dialysis. Several health system changes have been shown to increase PD use, such as targeted funding, PD First initiatives, or physician-inserted PD catheters. This review explores the factors that explain the considerable international variation in the use of PD and presents interventions that can potentially affect them., (Copyright © 2019 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Objectives: To compare the utility scores derived from the 5-level EuroQol 5-dimensional questionnaire (EQ-5D-5L), the visual analogue scale (VAS), and the 6-dimensional health state short form (SF-6D) in Thai patients on peritoneal dialysis., Methods: Data were obtained from the 36-Item Kidney Disease Quality of Life questionnaire and the EuroQol questionnaires (EQ-5D-5L and VAS) via face-to-face interview for 64 patients on peritoneal dialysis. We compared the ceiling effect of all the utility tools by calculating the proportion at the highest scores. The mean difference in utility scores defined by patients' demographic characteristics and clinical laboratory value was evaluated using independent t tests or the Mann-Whitney U test. Moreover, the correlation was assessed using the Pearson correlation coefficient. The agreements among the instruments were illustrated with the Bland and Altman plots., Results: The mean score of the EQ-5D-5L, SF-6D, and VAS were 0.801, 0.784, and 0.733, respectively. The EQ-5D-5L presented a higher percentage of the ceiling effect than did the SF-6D and VAS. The EQ-5D-5L was able to distinguish the mean difference between age groups with significant difference (P<.001). The Pearson correlation coefficients between utility scores and the 3 dimensions of the 36-Item Kidney Disease Quality of Life questionnaire had a significantly positive correlation, especially for the SF-6D. The Bland and Altman plots portrayed that the utility scores from the EQ-5D-5L were lower than those from the SF-6D and VAS among the patients in the poorer health state., Conclusions: Among the SF-6D, EQ-5D-5L, and VAS, only the EQ-5D-5L could distinguish the utility scores between different age groups. Nevertheless, the EQ-5D-5L presented the ceiling effect, whereas there was no evidence of the ceiling effect for the SF-6D. The SF-6D presented better correlation with the kidney disease-specific dimensions than did the EQ-5D-5L and VAS. Thus, the advantages and disadvantages of each utility tool should be considered., (Copyright © 2018 ISPOR--The professional society for health economics and outcomes research. Published by Elsevier Inc. All rights reserved.)

Background: Research on the association between cognitive impairment (CI) and peritoneal dialysis (PD)-related peritonitis is limited. Therefore, we investigated whether CI contributed to the risk of PD-related peritonitis. Methods: This prospective cohort study enrolled 458 patients from 5 PD centers between 1 March 2013, and 30 November 2013, and continued until 31 May 2016. We used the Modified Mini-Mental State Examination (3MS) to assess general cognition, the Trail-Making Test to assess executive function, and subtests of the Battery for the Assessment of Neuropsychological Status to assess immediate and delayed memory, visuospatial skills, and language ability. Patients were assigned to CI and non-CI groups based on their 3MS scores. The first episode of peritonitis was the primary endpoint event. Treatment failure of peritonitis was defined as peritonitis-associated death or transfer to hemodialysis. We used competing risk models to analyze the association between CI and the risk of peritonitis. The association of CI with treatment failure after peritonitis was analyzed using logistic regression models. Results: Ninety-four first episodes of peritonitis were recorded during a median follow-up of 31.4 months, 18.1% of which led to treatment failure. No significant group differences were observed for the occurrence, distribution of pathogenic bacteria, or outcomes of first-episode peritonitis. Immediate memory dysfunction was independently associated with a higher risk of PD-related peritonitis (hazard ratio [HR] 1.736, 95% confidence interval [CI] 1.064 - 2.834, p < 0.05), adjusting for confounders. Conclusions: Immediate memory dysfunction was a significant, independent predictor of PD-related peritonitis. Neither general nor specific domains of CI predicted treatment failure of peritonitis., (Copyright © 2019 International Society for Peritoneal Dialysis.)

Background: Patient-reported measures are increasingly recognized as important predictors of clinical outcomes in peritoneal dialysis (PD). We sought to understand associations between patient-reported perceptions of the advantages and disadvantages of PD and clinical outcomes., Methods: In this cohort study, 2760 PD patients in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) completed a questionnaire on their PD experience, between 2014 and 2017. In this questionnaire, PDOPPS patients rated 17 aspects of their PD experience on a 5-category ordinal scale, with responses scored from - 2 (major disadvantage) to + 2 (major advantage). An advantage/disadvantage score (ADS) was computed for each patient by averaging their response scores. The ADS, along with each of these 17 aspects, were used as exposures. Outcomes included mortality, transition to hemodialysis (HD), patient-reported quality of life (QOL), and depression. Cox regression was used to estimate associations between ADS and mortality, transition to HD, and a composite of the two. Logistic regression with generalized estimating equations was used to estimate cross-sectional associations of ADS with QOL and depression., Results: While 7% of PD patients had an ADS < 0 (negative perception of PD), 59% had an ADS between 0 and < 1 (positive perception), and 34% had an ADS ≥1 (very positive perception). Minimal association was observed between mortality and the ADS. Compared with a very positive perception, patients with a negative perception had a higher transition rate to HD (hazard ratio [HR] = 1.67; 95% confidence interval [CI]: 1.21, 2.30). Among individual items, "space taken up by PD supplies" was commonly rated as a disadvantage and had the strongest association with transition to HD (HR = 1.28; 95% CI 1.07, 1.53). Lower ADS was strongly associated with worse QOL rating and greater depressive symptoms., Conclusions: Although patients reported a generally favorable perception of PD, patient-reported disadvantages were associated with transition to HD, lower QOL, and depression. Strategies addressing these disadvantages, in particular reducing solution storage space, may improve patient outcomes and the experience of PD.