Centre Effects in Peritoneal Dialysis

Abstract

Peritoneal dialysis (PD)-related complications and outcomes have been shown to be influenced by both patient-and centre-level factors. There is a significant variability in outcomes across different centres, which is not explained by patient factors alone. This chapter aims to evaluate those modifiable centre-level factors that have been shown to impact PD outcomes, focussing specifically on peritonitis and technique failure, and the evidence that addressing these centre effects may lead to appreciable improvements in PD patient outcomes. Peritonitis rates have been shown to be related to a centre's degree of automated PD (APD) use, extent of icodextrin use, performance of home visits prior to PD commencement, the presence of a specialised PD nurse and duration of PD training. Better peritonitis outcomes have been shown to be associated with larger centre size, greater share of PD patients among dialysis cohorts and treatment of peritonitis with comprehensive empiric antimicrobial therapy. PD technique failure has been shown to be related to centre size and degree of PD experience. Although there is little evidence currently available to demonstrate that prospectively modifying centre factors improves PD outcomes, an Australian continuous quality improvement initiative has been associated with progressively improved peritonitis and technique failure outcomes.