On Growing Home: A Single-Centre Experience with a Dedicated Peritoneal Dialysis Access Clinic
Bibliographic record
Abstract
Background: Growing home dialysis programs has been a priority across Canada over the last decade. Initially a rise in home dialysis rates was observed across the country with initiatives targeting predialysis modality education, the use of transitional care units and increased utilization of assisted home dialysis programs. However, this growth has been challenging to sustain with observed attrition during the COVID-19 pandemic. In 2018, our center established a peritoneal dialysis (PD) access clinic as a means to streamline the process of establishing PD access for patients who had chosen PD as their modality of choice. Herein we describe our center's experience with this dedicated access clinic. Methods: We reviewed the charts of 29 prevalent predialysis patients who selected PD as their dialysis modality of choice and had an appointment with our PD Access Clinic (PDAC) between March 2021 and November 2022. We collected baseline data including eGFR (mL/min) and risk of progression to ESKD at 2 years' time (as measured by the Kidney Failure Risk Equation) at the time of their appointment, time to PD catheter access and first dialysis modality. We also collected information on unplanned dialysis starts, defined as hemodialysis access placed during hospital admission. Results: The mean (SD) patient age was 67 (14) years. Patients had an average eGFR of 10 mL/min and KFRE of 64% at the time of their initial PDAC appointment. There were a median of 3 months to PD catheter insertion from their access clinic appointment. Less than half of patients (45%) ended up on PD as their first dialysis modality and 20% of patients had an unplanned dialysis start. 17% remained predialysis at the time of our review. Conclusions: Dedicated PD access clinics do not ensure preferred dialysis modality. Unplanned dialysis starts occur with a high degree of frequency despite predialysis clinics. Earlier referral for PD access at higher eGFR may increase likelihood of peritoneal dialysis as the initial modality and would be a future area of study.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".