Date of Conferral

2017

Degree

Ph.D.

School

Public Health

Advisor

David Segal

Abstract

There are more than 2 million end stage renal disease (ESRD) patients in the world. ESRD is becoming more manageable with the advent of competent therapies such as peritoneal dialysis (PD) and hemodialysis (HD). While recent evidence suggests that switching from PD to HD may preserve residual renal function longer than either PD or HD alone as an alternative approach, little is known about the optimal timing and the long-term efficacy of switching dialysis modes. The purpose of this quantitative retrospective study, based on the bio-psychosocial model, was to investigate the optimal timing and determinants of the effectiveness of switching dialysis modes from PD to HD. Data were extracted from a national database of ESRD dialysis patients. The Kaplan-Meier survival curve and the log-rank test were used to determine the effect of optimal dialysis time for switching from PD to HD on ESRD patient's survival and mortality. The results showed the optimal duration for switching dialysis modalities was 9 months where patients had a 90% survival rate after switching. ESRD patients taking more than 24 months to switch modes had the highest loss of renal function. Also, patients between 40 and 80 years of age were at a significantly higher hazard of renal function loss than patients younger than 40 years of age. It was concluded that timely switching of dialysis mode from PD to HD increases survival in ESRD patients. Younger patients have better survival rates in peritoneal dialysis modality than older patients. Moreover, females switching from PD to HD have better survival rates than males. The positive social change implications of this study may help raise awareness to the importance of optimal timing when switching dialysis modalities for improved survival and quality of life.

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