Implementation of PDOPPS in a middle-income country: Early lessons from Thailand

Abstract

Background: Despite the implementation of a ‘Peritoneal Dialysis (PD) First’ policy in Thailand since 2008, nationwide PD practices and patients’ outcomes have rarely been reported. Methods: As part of the multinational PD Outcomes and Practice Patterns Study (PDOPPS), PD patients from 22 PD centres from different geographic regions, sizes and affiliations, representing Thailand PD facilities, have been enrolled starting in May 2016. Demographic, clinical and laboratory data and patients’ outcomes were prospectively collected and analysed. Results: The pilot and implementation phases demonstrated excellent concordance between study data and validation data collected at enrolment. In the implementation phase, 848 PD patients (including 262 (31%) incident PD patients) were randomly sampled from 5090 patients in participating centres. Almost all participants (95%) performed continuous ambulatory PD (CAPD), and a high proportion had hypoalbuminemia (67%, serum albumin < 3.5 g/dL), anaemia (42%, haemoglobin <10 g/dL) and hypokalaemia (37%, serum potassium < 3.5 mmol/L). The peritonitis rate was 0.40 episodes/year, but the culture-negative rate was high (0.13 episodes/year, 28% of total episodes). The patients from PD clinics located in Bangkok metropolitan region had higher socio-economic status, more optimal nutritional markers, blood chemistries, haemoglobin level and lower peritonitis rates compared to the provincial regions, emphasizing the centre effect on key success factors in PD. Conclusions: Participation in the PDOPPS helps unveil the critical barriers to improving outcomes of PD patients in Thailand, including a high prevalence of hypokalaemia, anaemia, poor nutritional status and culture-negative peritonitis. These factors should be acted upon to formulate solutions and implement quality improvement on a national level.

Predictors and outcomes of peritoneal dialysis-related infections due to filamentous molds (MycoPDICS)

“…Additionally, our study involved surveillance registry data specifically designed to optimize capture of fastidious organisms, including environmental molds, through specialized media, conditions, and techniques. This may have augmented detection of filamentous mold infections in peritonitis episodes in more recent years that would have previously been categorized as culture-negative [ 20 ].…”

Oral Health-Related Quality of Life, A Proxy of Poor Outcomes in Patients on Peritoneal Dialysis

“…The study rationale and methods have been published previously. 28 , 29 All reporting adhered to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines (Supplementary Item S1). 30 The study was approved by the Chulalongkorn University institutional review board and local ethics committees.…”

Dialysis and kidney transplant practices and challenges in Thailand

“…The physician‐to‐patient ratio is 64:1, whereas the PD nurse‐to‐patient ratio is 39:1, 12 causing a burgeoning workload for medical staff. Thai PD patients have an average age of 56 years and low education levels and household incomes (lower than $5000/year) 13 . These parameters are worse in patients located in rural areas.…”

“…While 81% of automated PD (APD) patients have no day dwell with an average total prescribed cycler volume per BSA of 11.0 L/1.73 m 2 12 . Icodextrin and Neutral pH low GDP solutions are not frequently used in Thailand, <5% 13,14 . The average weekly peritoneal KT/V is 1.73 and 1.75 in CAPD and APD patients, respectively 12 …”