An increasing number of patients with end-stage kidney disease (ESKD) are being initiated on long-term dialysis every year in Canada. Hemodialysis (HD) and peritoneal dialysis (PD) are the two main types of dialysis provided under Canadian renal care programs. In HD, the patient’s blood is circulated to an external dialysis machine, which filters wastes and extra water from the blood before returning it to the body. In PD, a permanent catheter affixed to the abdomen is used to fill the peritoneal cavity with a dialysis solution. The peritoneal membrane functions as a filter for wastes and extra water, and the dialysis solution is exchanged, either intermittently or continuously.

In all provinces, HD remains the modality most frequently used for new patients who require dialysis. In 2013, the rate of ESKD patients initiated on HD varied from 91% in Newfoundland and Labrador to 71% in Manitoba. Moreover, for the same year, most Canadian dialysis patients (76%) received in-centre HD — HD performed in an institution such as a hospital, satellite unit, or a dialysis facility, with the assistance of a health care professional.

In contrast, home-based therapies such as PD and home HD show low rates of usage according to the latest available data. In 2013, about 19% of new ESKD patients in Canada were initiated on PD, while this rate was 0.6% for home HD. For the same year, the prevalence for patients being treated by home dialysis across the country was about 17% for PD and 2.5% for home HD.

Available evidence suggests that PD and home HD may achieve similar clinical outcomes for some patients compared with in-centre HD. Studies also indicate that PD and home HD are potentially more cost-effective relative to in-centre HD. Based on the potential comparable clinical effectiveness and potential cost savings that they may yield, it is often argued that home dialysis therapies, particularly PD, may be underutilized in eligible patients in Canada and other developed countries. Similarly, the literature and jurisdictional input suggest growing interest in other dialysis delivery models, namely, “self-care” in-centre HD, “assisted” PD, and home HD. These options may allow for effective clinical results while being potentially less costly than standard in-centre HD and may also be more desirable from a patient and caregiver perspective.

Contents

• Revision History
• Rationale And Policy Issues
  • Policy Questions
• Objectives
• Research Questions
• Methods
  • Search Strategy
• Clinical Review
  • Study Design
  • Selection Criteria
  • Screening and Selecting Studies for Inclusion
  • Data Extraction
  • Quality Appraisal
  • Summary of Evidence
• Economic Review
  • Model Design
  • Perspective
  • Resource Use and Cost Data
  • Utilities
  • Clinical Parameters
  • Outcomes
  • Time Horizon and Discounting
  • Sensitivity Analysis
  • Assumptions
• Patient Experiences And Perspectives
  • Study Design
  • Eligibility Criteria
  • Screening and Selecting Studies for Inclusion
  • Data Extraction
  • Methodological Assessments
  • Data Analysis
• Ethical Issues
  • Inquiry
  • Review of the Bioethics Literature
  • Literature Screening and Selection
  • Perspectives
  • Data Extraction and/or Abstraction Strategy
  • Analysis
  • Summarizing and Presenting Results
• Implementation Issues
  • Methods
  • Targeted Literature Search
  • Data Analysis
  • Perspective
  • Outputs
• Areas For Potential Amendments
• References
• Appendix 1. Literature Search Strategy
• Appendix 2. Analytical Framework
• Appendix 3. Clinical Search Full-text Screening Checklist
• Appendix 4. Clinical Review Data Extraction Forms
• Appendix 5. Quality Appraisal For Studies Included Within The Clinical Review
• Appendix 6. Data Extraction Form — Patient Perspectives And Experiences Review
• Appendix 7. Project Team Members And Roles

Suggested citation:

Dialysis modalities for the treatment of end-stage kidney disease: a health technology assessment - project protocol. Ottawa: CADTH; 2016 Jun. (CADTH optimal use report; vol.6, no.2a).

This report is prepared by the Canadian Agency for Drugs and Technologies in Health (CADTH). This report contains a comprehensive review of existing public literature, studies, materials, and other information and documentation (collectively the “source documentation”) available to CADTH at the time it was prepared, and it was guided by expert input and advice throughout its preparation.

The information in this report is intended to help health care decision-makers, patients, health care professionals, health systems leaders, and policy-makers make well-informed decisions and thereby improve the quality of health care services. The information in this report should not be used as a substitute for the application of clinical judgment in respect to the care of a particular patient or other professional judgment in any decision-making process, nor is it intended to replace professional medical advice. While CADTH has taken care in the preparation of this report to ensure that its contents are accurate, complete, and up-to-date, CADTH does not make any guarantee to that effect. CADTH is not responsible for any errors or omissions or injury, loss, or damage arising from or as a result of the use (or misuse) of any information contained in or implied by the information in this report.

CADTH takes sole responsibility for the final form and content of this report. The statements, conclusions, and views expressed herein do not necessarily represent the view of Health Canada or any provincial or territorial government.

Production of this report is made possible through a financial contribution from Health Canada.

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