LSU Health study finds psychosocial factors may drive peritoneal dialysis patient dropout

February 19, 2021

New Orleans, LA - A retrospective study conducted by LSU Health New Orleans reports that contrary to previous research, most patients who drop out of peritoneal dialysis may do so for psychosocial reasons. The findings are published in The American Journal of the Medical Sciences, available here. The paper inspired a companion editorial, available here.

The research team evaluated the reasons that 27 of the 83 patients enrolled in the peritoneal dialysis program withdrew between 2016 and 2018. Twenty-four or 86% were African American. They found that psychosocial factors, including mental health illness such as anxiety and depression, loss of support networks, or inability to tolerate the number of treatment sessions required by peritoneal dialysis, accounted for 63% of the dropout rate due to controllable factors.

According to the National Institutes of Health, peritoneal dialysis is a treatment for kidney failure that uses the lining of the abdomen to filter blood inside the body. The dialysis solution flows into the belly through a catheter, where it absorbs wastes before draining. The process must be done four to six times a day. Patients can perform peritoneal dialysis at home, work or when traveling.

Patients with end-stage renal disease must undergo either peritoneal dialysis or hemodialysis - a method of filtering waste from the blood through a filter outside the body called a dialyzer.

The researchers note that the United States accounts for the largest percentage of end-stage renal disease patients in the world but significantly underutilizes peritoneal dialysis despite its lower costs and a lower first-year risk of death. Peritoneal dialysis can also be more accessible because patients don't have to travel to treatment centers. Other advantages include greater flexibility in treatment schedules, potentially fewer dietary restrictions and fewer side effects like nausea, vomiting and cramping.

The National Institutes of Health estimates that more than 661,000 Americans have kidney failure, and that of these, 468,000 are on dialysis. Compared to Caucasians, end-stage renal disease prevalence is about 3.7 times greater in African Americans, 1.4 times greater in Native Americans, and 1.5 times greater in Asian Americans. Each year, kidney disease kills more people than breast or prostate cancer. In 2013, more than 47,000 Americans died from kidney disease.

"Early intervention or identification of these problems will allow for physicians and care teams to improve not only patient outcomes but also improve the patient's quality of life," notes Hayden Torres, a third-year medical student at LSU Health New Orleans School of Medicine and also first author of the paper.

The research team concludes that both patients and caregivers may benefit from both counseling and assisted dialysis programs. Future research should focus on ways to improve pre-PD training depending on the type of patient beginning treatment, improving interventions for psychosocial factors that lead to dropout, and developing ways to identify sources of psychosocial problems before they impact patients.

Biruh T. Workeneh and Sreedhar Mandayam from the Department of Nephrology at the University of Texas at MD Anderson Cancer Center wrote in their editorial, "As Torres et al. have expertly illustrated, examining the reasons for technique failure is critical particularly in special populations because they have to reveal factors that may not be apparent and point to areas to focus further research and policy prescriptions. As the manuscript shows, psychosocial factors are a significant factor that has not received enough attention. Not surprisingly, their investigation found that when technique failure results from psychosocial factors, it does so in the first year, which is consistent with other reports. Torres et al. have effectively and poignantly highlighted a need for further research about how to retain racial minorities more effectively, who may not have robust social and emotional support."
In addition to Torres, authors include Mihran Naljayan, MD, Maria Frontini, DVM, PhD, Erwin Aguilar, PharmD, MSc, MPH, Sean Barry, BSc, and Efrain Reisin, MD in the LSU Health New Orleans School of Medicine's sections of Nephrology and Hypertension and Infectious Diseases.

LSU Health Sciences Center New Orleans educates Louisiana's health care professionals. The state's flagship health sciences university, LSU Health New Orleans includes a School of Medicine with branch campuses in Baton Rouge and Lafayette, the state's only School of Dentistry, Louisiana's only public School of Public Health, and Schools of Allied Health Professions, Nursing, and Graduate Studies. LSU Health New Orleans faculty take care of patients in public and private hospitals and clinics throughout the region. In the vanguard of biosciences research in a number of areas in a worldwide arena, the LSU Health New Orleans research enterprise generates jobs and enormous economic impact. LSU Health New Orleans faculty have made lifesaving discoveries and continue to work to prevent, advance treatment, or cure disease. To learn more, visit,, or

Louisiana State University Health Sciences Center

Related Dialysis Articles from Brightsurf:

Immediate dialysis no better than wait-until-necessary approach, researchers find
In the largest international study of its kind, researchers at the University of Alberta and Toronto's St.

Predictors of 5-year mortality in young dialysis patients
The analysis published in NDT [1] evaluated for the first time the association of a large number of demographic, HD treatment and laboratory variables with mortality in patients on chronic hemodialysis treatment since childhood.

COVID-19 mortality alarmingly high in dialysis patients
Analysis of a Spanish experience shows that COVID-19 is frequent in hemodialysis patients, who appear to be at risk for worse outcome.

Survival following switch from urgent in-center hemodialysis to home dialysis
Few patients who start urgent and unplanned dialysis in clinical centers switch to home dialysis.

Is ownership of dialysis facilities associated with access to kidney transplants?
An analysis that included data for nearly 1.5 million patients with end-stage kidney disease looked at whether ownership of dialysis facilities was associated with patients' access to kidney transplants.

At-home dialysis improves quality of life
The rate of people starting voluntary at-home peritoneal dialysis rose from 15% to 34% over 10 years at Kaiser Permanente in Northern California, providing a convenient and safe way to manage advanced-stage kidney disease compared with center-based hemodialysis, according to research published today in JAMA Internal Medicine.

Hydration sensor could improve dialysis
Researchers from MIT and Massachusetts General Hospital have now developed a portable sensor that can accurately measure patients' hydration levels using a technique known as nuclear magnetic resonance (NMR) relaxometry.

Uncovering possible role of polyphosphate in dialysis-related amyloidosis
Researchers from Osaka University found that the low concentrations of the naturally occurring biopolymer, polyphosphate (polyP), induces amyloid formation from β2 microglobulin under both acidic and neutral conditions but by different mechanisms.

Study compares dialysis reimbursement around the globe
Dialysis reimbursement policies in most countries are focused on conventional in-center hemodialysis, although home hemodialysis and peritoneal dialysis might contribute to quality of life and cost savings.

Elderly patients on dialysis have a high risk of dementia
Older kidney disease patients who are sick enough to require the blood-filtering treatment known as dialysis are at high risk of dementia, including Alzheimer's disease, according to a study led by scientists at Johns Hopkins Bloomberg School of Public Health.

Read More: Dialysis News and Dialysis Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to