MON-069 OVERCOMING SHORTAGE OF PERITONEAL DIALYSIS SOLUTION IN NEPAL

Abstract

Shortage of medical supplies has a negative impact on the health of people. Though manufacturers and suppliers apprehend shortages due to increased demands, it may be inevitable in circumstances such as war, earthquakes, and hurricane. There are some circumstances when companies halt production for various reasons. Continuous ambulatory peritoneal dialysis (CAPD) as an option for end-stage kidney disease patient in Nepal started in 2007. The PD Solution was purchased from Baxter, India. The supply was severely disrupted twice in 2018 (for 45 days in February-March and 58 days in May-June of 2018) when Baxter, India halted its production. To address this shortage, suppliers had to purchase from Baxter, Phillipines. This study describes the impact of the shortage and how the patients overcome the period of shortage In this retrospective study after the period of the shortage, the patients were interviewed face to face or on phone by a single CAPD coordinator. Those willing to give their information for the study were recruited. Name, age, sex, the indication of CAPD, PD vintage, actual prescription and modified prescription, the source of PD solution at the time of shortage, manipulations, switch to hemodialysis, and any complications encountered were noted. There were 113 patients between the age of 9 and 82 years (mean 51 +/- 1.76 years) who participated in the study. Sixty-eight were male patients and 45 female patients who were registered at 10 different centers of 6 cities. Most of the patients (74.33%) claimed to have been self-motivated for CAPD while 21.24% of the patients had taken CAPD as their hemodialysis access were exhausted. Three patients had started CAPD within a month while one had been on CAPD for last 7 years. Most of the patients (85.84%) of the patient were performing 3 bag/ day exchange before the crisis. 9.73% of the patients were performing 4 bags/day. All the patients seemed to be unaware of the impending crisis of PD solution and running out of fluid for a few days to weeks. Average number of days patients did not have adequate PD solution was 24.58 +/- 1.42 days. All of the patients reduced the number of exchanges per day to minimize the number of bags used. Three patients purchased Icodextrin though it is not readily available and expensive than dextrose-based PD Solution. At the time of crisis, 23.89% of the patients had turned to their doctor for solution while 19.47% consulted their CAPD coordinator. Two patient reported burrowing from other patients or hospital. Fifty-four patients purchased from alternative sources including black-market and from the neighboring country, India. When the modified CAPD prescription seemed inadequate, the patient were put on hemodialysis. Nine patients received few sessions of hemodialysis to bridge the gap. Out of 113 patients, 30 patients had to be admitted for 8.8 days due to different complications. Some of the complications included peritonitis, fluid overload, dyselectrolytemia, and death. Nine of the patients had died during the period. The incidence of peritonitis had also increased with 16 patients having peritonitis during the period of crisis. Shortage of PD solution should be perceived and prepared for. Crisis due to the shortage of PD solution is detrimental to the health of the patient leading to different complications and even death of the patients.