Focus on peritoneal dialysis training: working to decrease peritonitis rates

Abstract

Patient training has widely been considered to be one of the most critical factors for achieving optimal peritoneal dialysis clinical outcomes, including avoidance of peritonitis. However, research in this important area has been remarkably scant to date. This article will critically review the clinical evidence underpinning PD patient training and will specifically focus on four key areas: who should provide training and how, when and where should it be performed to obtain the best results. Evidence gaps and future research directions will also be discussed.

The Current State of Peritoneal Dialysis

“…179 Single center observational studies from different parts of the world, as well as multinational national registry studies have reported that the rates of PD-related infections have steadily decreased over the last 10-20 years. 180,[186][187][188][189][190][191][192][193] Within Australia, country-wide PD-related peritonitis rates fell significantly by 37% over a 5-year period from 0.62 episodes per patient-year in 2008 to 0.39 episodes per patient-year in 2013 after a concerted, multidisciplinary and multipronged national peritonitis reduction campaign involving quarterly audit and feedback of individual unit peritonitis rates, prioritization of peritonitis prevention trials by the Australasian Kidney Trials Network, updating national clinical practice guidelines on peritonitis, launching peritonitis guideline implementation projects, publishing of a call to action paper, establishment of a PD Academy to provide PD training to junior nephrologists and nursing staff, and development of a Home Dialysis Network to support home dialysis patients (http:// homedialysis.org.au/). 161,[180][181][182][183][184][185] These reductions have been variously attributed to the use of twin bag disconnection systems, implementation of mupirocin chemoprophylaxis protocols, topical exit site application of gentamicin, coprescription of nystatin or fluconazole with antibiotic therapy, improved training of PD patients and/or staff, and better identification and targeting of peritonitis risk factors.…”

“…[194][195][196][197][198][199] Despite these improvements, there remains a wide and unacceptable variation in reported rates from different countries, ranging from 0.06 episodes/ year in Taiwan to 1.66 episodes/year in Israel. 161,192,201,202,204,205 A previous national survey found highly variable and generally poor compliance of centers with clinical practice guidelines for prevention of peritonitis. 203 The sources of these variations have not been adequately investigated but may relate to center-related factors, such as unit size, topical antibiotic prophylaxis, or PD training practices.…”

Implementing Assisted Peritoneal Dialysis in Renal Care: a Chinese-German Perspective

“…At level 4, PD patients are full-time or part-time employees, who can take care of themselves and undertake at least one social participation activity. Young PD patients must pass PD training assessment in hospital with the full score every 3 months [19,24]. They can work in a hospital to help the hospitalized elder PD patients, visit patients who require assPD at their homes at regular intervals.…”

Peritoneal dialysis practice in Australia and New Zealand: A call to sustain the action

“…This education programme, developed by experienced PD trainers, aims to safely demonstrate procedures associated with PD and helps patients recognize contamination and take appropriate action . Despite this, two recent reviews have identified significant evidence gaps in PD learning and teaching, with an evaluation of the ISPD approach yet to be published . Therefore, the optimal education package is yet to be established, and it is highly likely that further gains to the clinical outcomes of PD may be realized .…”