Home Dialysis Training Needs for Fellows: A Survey of Nephrology Program Directors and Division Chiefs in the United States

Why are we Not Getting More Patients onto Peritoneal Dialysis? Observations From the United States with Global Implications

“… 32 Similarly, in a very recent survey, only 72% of nephrology training program directors believe that every fellow graduating from their program is capable of providing PD care without supervision. 33 There are courses in the United States that are targeted at increasing knowledge of home dialysis therapies, for example, the Home Dialysis University sponsored by the International Society for Peritoneal Dialysis. The American Society of Nephrology has very recently partnered with the Home Dialysis University to offer a limited number of scholarships to support nephrology trainees to attend this course; the long-term impact of this remains to be determined.…”

Peritoneal Dialysis: Are We Approaching a Modern Renaissance?

“…7 Finally, few nephrology trainees are prepared to provide PD upon graduation, and shortages in nurses experienced in PD culminate in decreased uptake of PD. 8,9 The current decade has created incredible opportunities for innovation in PD. First, several countries have renewed their focus on PD in recent years, in part because of a broader push to improve home-based care at reduced costs to payers.…”

“…The Past: From Peritoneal Lavages in Ancient Egypt to Flush-before-Fill Technology PD developed over five major periods: (1) the pre-20th/early 20th century, when scientists learned to access the peritoneum and use it to treat acute and chronic kidney diseases; (2) the Second World War and postwar period, which led to an urgent need to find treatments of kidney disease; (3) the 1970s and 1980s, when PD technologies grew and infection rates fell; (4) the 1990s-2010s, when PD use stagnated in several countries; and (5) the present, where PD is emerging as a therapy to improve patient-centered care. [3][4][5][6][7][8] In the pre-20th century, scientists in Ancient Egypt saw the peritoneum as an access point for human physiology and conducted peritoneal lavages. 3 As abdominal surgery developed, physiologists went one step further and began to experiment with the idea of using the peritoneum to exchange substances.…”