technique failure. o Provider Factors: No studies reported on provider factors associated with PD technique survival. o Patient Factors: African-American or indigenous race, increased BMI or obesity, elevated systolic blood pressure, use of HD before switching to PD, and peritoneal dialysis catheter problems were associated with higher rates of technique failure but each factor was reported in 4 or fewer of the 14 included studies. Mixed results were found for presence of diabetes, age, gender, distance from clinic/nephrologist, and need for assisted PD. · Five studies (none from the US) reported factors associated with HHD technique failure: o Health Care System Factors: No studies reported on health care system factors associated with HHD technique survival. o Provider Factors: No studies reported on provider factors associated with HHD technique survival. o Patient Factors: Interference with home life, lack of carer support, caregiver anxiety, inability to perform cannulation, medical issues (including diabetes and access problems), and increased age were associated with increased technique failure in 4 studies; one identified no significant predictors of technique failure. Another study reported no difference in a composite outcome of time to all-cause hospitalization, technique failure, or death in patients categorized as dependent on or independent of assistance with nocturnal HHD. Health Care System Factors (Appendix C, Table 5) One study reported on facility factors associated with the provision of home-based treatment (either HHD or PD). 79 The cross-sectional study, done in the US, surveyed 4,653 dialysis facilities. Overall, 7.1% of patients (range across facilities 0% to 100%) were on home-based dialysis. Higher provision of home-based dialysis was associated with larger dialysis facilities (≥ 62 patients vs < 62 patients), more years of facility Medicare certification, a higher percentage of employed patients, and a higher percentage of patients between ages 18 and 54 years. Lower provision of home-based dialysis was associated with more rural location, location in a geographically larger zip code area, location in a zip code of high population density, facility offering a shift starting at 5 pm or later, facility that is part of a chain, facility with higher treatment capacity (determined by number of patients, number of stations, and presence or absence of a late shift), and higher percentage of black patients. “For-profit” status was not significantly associated with home-based dialysis. Lack of resources to support home-based 42 Home-based versus In-center Dialysis Evidence-based Synthesis Program dialysis in smaller, more rural areas and unmeasured confounding factors may account for these findings. Another study provided information on training time.80 All 87 patients in the study received training on HHD; those randomized to nocturnal HHD underwent additional training. Eight patients were excluded from the analysis of training time. The mean number of training sessions was 28 (range 11 to 59) but no significant difference was noted in training time required for conventional HHD versus nocturnal HHD. Less training time was needed for patients with experience in self-care or both self-care and cannulation while a higher comorbidity score and higher age were related to increased training time required. Training time needed was not related to tests of cognition, education level, or SF-36 Physical Function. Provider Factors/Provider Perspective (Appendix C, Table 5) Peritoneal Dialysis Selection An Australian study asked nephrologists and chronic kidney disease (CKD) coordinators about information provided to CKD patients prior to selecting a dialysis modality. 81 Among 588 patients who progressed to dialysis, 17.5% did not receive information about treatment options. Patients known to the nephrologists for more than 3 months and patients treated at smaller renal units (< 100 patients) were more likely to receive information. Reasons for not providing information about PD included medical/surgical contraindications, unsuitable living conditions, low literacy, psycho-social contraindications, refusal by patient or family, option not available via service provider, and acute presentation. A multidisciplinary team (nephrologist, pre-dialysis nurse, PD nurse and/or acute care nurse, social worker) determined contraindications, barriers to self-care, and availability of support in the home for 497 Canadian ESRD patients who had already undergone a minimum of one dialysis treatment. 82 Medical (obesity, abdominal scarring, ascites, diverticulitis, abdominal hernia) and social (residence or work did not permit PD) contraindications to PD were identified for 110/497 (22%). Barriers to self-care were identified for 245/387 (63%). Patient with barriers were older, more likely female, of lower weight and BMI, more likely to have a cardiovascular condition or cancer, and more likely to have started dialysis as an inpatient and at a higher eGFR. Barriers were categorized as physical (decreased strength, manual dexterity, vision, or hearing, immobility, poor health, or poor hygiene) or cognitive (language, history of non-compliance, psychiatric condition, dementia/poor memory). Among patients with barriers to self-care, those with family support were more likely to be eligible for PD (OR 3.1 [95% CI 1.6,