Peritoneal Dialysis and Strategies for its Diffusion: The Solutions of Piedmont Region; Critical Analysis of the Results and New Frontiers

Abstract

The well-known phenomenon of gradual reduction of patients undergoing haemodialysis (HDD) or peritoneal dialysis (PD) treatment at home seems to be caused by aging of incident patients, comorbilities, loneliness, and the presence of cultural and organizational obstacles. A measure approved by the Piedmont region (D.G.R. 8–12316 - October 12, 2009) provides a financial contribution supporting home dialysis (HoD). The amount of the contribution depends on a scoring system (Home Dialysis Assistance Plan - P.A.I.D.D.) assessing each patient for his lack of independence in managing the treatment. The final score identifies the patients' assistance needs and, thus, the amount of financial support, also according to the type of treatment and caregiver. At the end of the first 3-year period of use of the measure, the overall population on dialysis was stable; incidence and prevalence of HoD patients increased in 2010 and remained stable in the period 2011–2012. It is possible that this measure can effectively reverse the incidence and prevalence trend of HoD patients: in fact, it turned out to be a potentially powerful tool, despite not being sufficient by itself. Analysis of further means to integrate this measure are currently undergoing in Piedmont, in order to facilitate the solution of other problems, including the poor motivation of nefrologists, prejudice, and the lack of knowledge and background on the issue of home dialysis.