60% of peritoneal dialysis caregivers experience burnout

Among caregivers of peritoneal dialysis (PD) patients -- typically a spouse, parent, or adult child -- 60% experience mild to moderate burnout and 13% experience moderate to severe burnout as measured by the Zarit Burden Interview. 25% of home dialysis caregivers spend more than 5 hours per day on caregiving tasks. This burnout directly harms patients: in a study of 180 PD patient-caregiver pairs, 42% of patients hospitalized for peritonitis had a caregiver experiencing burnout. Peritonitis (infection of the peritoneal lining) is the leading cause of PD failure and switch to in-center hemodialysis. Burned-out caregivers make sterile technique errors during bag exchanges, forget to order supplies, or miss early signs of infection. The structural reason: home dialysis policy treats the caregiver as free labor. Medicare pays for patient training (typically 15+ hours over 5-8 days with a 1:1 nurse ratio), but provides zero ongoing support, respite care, or compensation for caregivers. There is no 'caregiver training' requirement, no burnout screening, and no funded respite program. When the caregiver breaks down, the patient goes back to in-center HD, costing Medicare far more money.