Abstract
Background: In addition to the economic evaluation and budget impact information of dialysis in patients with end-stage renal disease (ESRD) obtained from sub-project 1, social impact and problems related to dialysis would be very useful information which can be applied as evidences for policy decision making. Objective: To study the social impact and problems related to dialysis in patients with ESRD using (1) continuous ambulatory peritoneal dialysis (CAPD) (2) CAPD using icodextrin one cycle per day of icodextrin plus glucose (CAPD+ICO) and (3) automated peritoneal dialysis (APD) methods as well as in all stakeholders providing care for ESRD patients. Methods: This study applied a mixed method which quantitative data of all patients participating in sub-project 1 were collected using a self-administrative questionnaire and qualitative data were obtained using in-depth interviews and focus group discussion among patients/relatives, healthcare personnel in service units related to dialysis services for ESRD patients. Results: According to the results of surveys using questionnaires, it was found that ESRD patients were relatively well equipped with reagent storage sites. In addition, CAPD patients undergoing peritoneal dialysis had more limitations in their daily lives than those receiving APD, however, there was no statistically significant difference. CAPD+ICO dialysis patients were reported to be statistically significantly more complicated than APD and CAPD dialysis. This may be due to a shorter pre-dialysis period for patients undergoing CAPD+ICO dialysis (51.9 months) than those undergoing CAPD (65.3 months). Most ESRD patients receiving APD reported that the absence of fluid during the day resulted in feeling better and more independent to the greatest degree. For patients undergoing CAPD+ICO, icodextrin was found to improve hyperhydration and decrease fatigue. Conclusions: APD is appropriate for pediatric patients, working adults, people who cannot perform dialysis during the day and old people who are unable to do dialysis on their own, but will have a caregiver to do it. However, if APD is included in the benefit package, the expansion of services with APD will require more healthcare personnel, especially peritoneal dialysis nurses and training. The system should be developed in conjunction with the service provider to provide an efficient service system for providing services to the patient.
