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St. Michael’s Dr. Jeff Perl receives $1.4 million to discover home dialysis best practices

Toronto, November 28, 2013

By Evelyne Jhung

Dr. Jeffrey Perl reviews tips for home dialysis use with patient Make Kazaklis at a recent follow-up appointment. Kazaklis has been on home dialysis for the past year and eight months.
Dr. Jeffrey Perl reviews tips for home dialysis use with patient Make Kazaklis at a recent follow-up appointment. Kazaklis has been on home dialysis for the past year and eight months. (Photo by Katie Cooper, St. Michael's Hospital)

Dr. Jeffrey Perl, a nephrologist, was awarded a Canadian Institutes of Health Research grant of $1.4 million over four years to support his research into best practices in home peritoneal dialysis.

Fewer than 20 per cent of kidney patients are treated with home peritoneal dialysis, where a catheter is inserted into a patient’s stomach to clean waste products and excess water from his or her blood while still in the body. The majority of patients opt for hospital-based hemodialysis – coming to the hospital to get their blood cleaned in a machine.

“Compared to hemodialysis at a hospital, home peritoneal dialysis is associated with similar survival, superior patient satisfaction and is administered at home by a patient or caregiver at a lower cost,” said Dr. Perl. “It also allows patients to manage their own therapy and live a relatively flexible lifestyle, including travel.”

It is for these reasons – improving patient outcomes and minimizing the health care costs of dialysis therapy – that Dr. Perl is investigating how to increase the use of home peritoneal dialysis among patients with kidney disease.

The Peritoneal Dialysis Outcomes and Practice Patterns Study was developed under the leadership of Dr. Perl, in collaboration with Canadian researchers and the Arbor Research Collaborative for Health, an organization formerly known as the University Renal Research and Education Association that conducts major studies in epidemiology and public health. More than 30 per cent of Canadian patients on peritoneal dialysis will ultimately require a transfer to hemodialysis after three years, so the focus of this study is to determine why and whether they relate to patient outcomes.

“The international study includes sites in Japan, the U.K., the USA and Canada, and will allow us to compare regional and international differences in patient treatment and outcomes,” Dr. Perl said. “It will be one of the largest studies following patients on home dialysis and will include 20 sites across Canada.”

The home peritoneal dialysis study will collect information on the differences in how facilities care for peritoneal dialysis patients, patient characteristics, causes of technique failure, and quality of life, and will follow patients over three years.

“After three years, we see about 50 per cent of patients on home peritoneal dialysis switch to hospital dialysis,” Dr. Perl said. “The results of this study will tell us why and then hopefully, we can identify best practices in order to prolong the time patients spend on home peritoneal dialysis, thus giving them better outcomes and quality of life. We’re looking to identify different practices in how patients on home peritoneal dialysis are cared for at the participating sites in Canada and compare these to the participating facilities in other countries. I think we’ll see that the rates of treatment-related complications, some of which will hopefully be modifiable by identifying best practices, vary significantly.”

The pilot phase of the study, which includes three sites in Canada, including St. Michael’s, was expected to start in October, and the longitudinal study (the remaining sites) will start in January.

The Canadian component of the study is funded through a joint industry grant with Baxter Healthcare International and the CIHR. The international component is sponsored by Baxter Healthcare International, Fresenius Medical Care and the Japanese Society of Peritoneal Dialysis.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.