Economic impact of extended time on peritoneal dialysis as a result of using polyglucose: the application of a Markov chain model to forecast changes in the development of the ESRD programme over time

BACKGROUND: The use of polyglucose as a peritoneal dialysis (PD) fluid extends time on PD treatment. It is anticipated, therefore, that the share of patients treated with PD will be positively influenced. The relationship between extension of PD treatment time and an increase of the PD treatment share, however, is complex and needs further investigation. In this paper, a Markov chain model was applied to investigate the impact of extended time on PD treatment for the PD share in all dialysis patients in The Netherlands. Furthermore, the economic impact of the extended time on treatment (ETOT) was explored. METHODS: Scenarios were forecast over a 10 year period using aggregate data from the End-Stage Renal Registry in The Netherlands (Renine). Three scenarios were simulated in which the median PD technique survival was extended by 8, 10 and 12 months. Two other scenarios explored the impact of the combined effect of ETOT of 10 months together with a 10% and 20% increase of PD inflow shares. Reductions of costs to society due to ETOT were estimated using Dutch cost data on renal replacement therapies. RESULTS: PD share increases from 30.0% in the null scenario to 34.5% in the scenario with an ETOT of 10 months and an increased PD inflow share of 20%. The reduction in total costs to society of the renal replacement therapies is 0.96%. The average societal costs per discounted patient year for haemodialysis (HD) are 84 100 euros. For PD, these costs are 60 300 euros. A shift from HD to PD results in average cost savings of 28% per patient year. CONCLUSIONS: In view of high dialysis costs to society, a reduction of 0.96% can be considered to be relevant for healthcare policy makers

Effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in patients with chronic kidney disease

Since about three decades, inhibitors of the renin-angiotensin system have been available in clinical practice. Although angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) were primarily aimed at treatment of hypertension and heart failure, more of their positive effects were discovered later on. Patients with chronic kidney disease were recognised to profit the most from treatment with these agents; however some blind spots are still present. Patients with advanced renal failure are almost always excluded from the trials; patients with end-stage renal disease form the least studied population of all and outcomes of treatment with ACEi/ARB are still uncertain in these cohorts. The aim of this review is to summarise and update the evidence about effects of All inhibitors in patients with chronic kidney disease with the specific emphasis on patients treated with dialysis. Lately a novel indication for ACEi/ARB administration, especially for peritoneal dialysis patients, has been proposed. It is based on the capacity of these drugs to inhibit the local tissue renin-angiotensin system, which results in less development of peritoneal fibrosis and a longer life for the peritoneal membrane. The most recent available data are presented in this review.Clinical epidemiolog

Isolation, identification, and analysis of 4-acetylaminophenol-glucuronide in body fluids of dialyzed renal patients; a molecular mass marker for peritoneal diffusive transport

A noncharacteristic solute, appearing in gradient elution liq. chromatog. (HPLC) profile of body fluids of dialyzed renal patients, was isolated and identified by preparative HPLC, b-glucuronidase-induced enzymic peak shift, and mass spectrometry. The compd. was shown to be p-acetylaminophenol (paracetamol)-glucuronide (PG). Serum and peritoneal dialyzate PG concns. were detd. in a no. of patients. Cuprophan in vivo dialyzer clearances were calcd. Peritoneal membrane mass transfer coeffs. (MTC) of PG were calcd. and compared with those of mol. mass markers for peritoneal diffusive mass transport studies (urea, creatinine, uric acid, and inulin). By extrapolation of an MTC vs. mol. mass calibration line for urea, creatinine, and uric acid it is shown that PG behaves as expected from its mol. mass. Thus, mass range between Mr 200 and 500. It may also be used as a marker for diffusive solute transport in hemodialysis treatment. The HPLC gradient elution technique used here appears to be suitable for the simultaneous anal. of the mol. mass markers creatinine, uric acid, and paracetamolglucuronid

Peritoneal Albumin and Protein Losses Do Not Predict Outcome in Peritoneal Dialysis Patients

Clinical epidemiolog