Barriers and Facilitators to Staying on Peritoneal Dialysis from the Perspective of Black and Latino Patients with Kidney Failure – A Qualitative Study

Abstract

Introduction: Despite being associated with better quality of life, lower cost, and longer preservation of residual kidney function compared to hemodialysis (HD), peritoneal dialysis (PD) is underutilized for Black and Latino patients with kidney failure. The objective of this study was to identify barriers and facilitators to dialysis retention among Black and Latino patients with kidney failure. Methods: We conducted a qualitative study using in-depth, semi-structured interviews of adult Black and Latino patients currently on PD. Interviews were conducted in English and Spanish, transcribed verbatim, and analyzed using constant comparison method,1 guided by Andersen’s behavioral model for health services use.2 Results: Our sample consisted of 2 Black English-speaking and 7 Latino Spanish-speaking participants (mean age 48 years, 67% female, mean duration on PD 38 months). Facilitators to PD retention included positive attitudes towards PD, self-efficacy to perform dialysis at home, access to a supportive and readily available dialysis team, and family support. Barriers to PD retention included lack of Spanish-speaking dialysis providers, and underuse of professional medical interpreters for Spanish-speaking participants. The initiation of PD was noted to have a negative impact on mental health and mobility and required unanticipated adaptation to both work and social schedules for patients and their caregivers. Despite reporting PD-associated complications and symptoms, almost all participants reported an overall positive change in their health and quality of life since starting PD. All participants reported that they would still choose PD over other dialysis modalities if given the choice. Conclusions: Provision of high-quality language assistance services or bilingual providers and preparation for transitioning to home PD may improve patient experience and PD retention. This work leverages patient experience to identify areas for future interventions aimed at addressing the equity gap in home dialysis for Black and Latino patients with kidney failure. 1. Miles MB, Huberman AM, Saldaña J. Qualitative Data Analysis : A Methods Sourcebook. Fourth ed. Los Angeles: SAGE, 2020.2. Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc 1973;51(1):95-124. (https://www.ncbi.nlm.nih.gov/pubmed/4198894).