Peritoneal access – a pressing problem

Abstract

In Portugal, as well as in Europe, peritoneal dialysis (PD) use remains low. Reorganization of PD units including a well -structured peritoneal access management protocol are fundamental to improve the take -up of this therapy. We analyzed the procedure and outcomes in a PD unit, addressing two key quality questions: at which level of estimated glomerular filtration rate (eGFR) were patients referred to peritoneal catheter placement and whether if it was timely placed. We retrospectively evaluated all patients submitted to catheter placement between 2017 and June 2020. We analyzed the patient journey from Kidney Replacement Therapies (KRT) Option Appointment, until PD start, as well as demographic and clinical variables, including eGFR at four time points (KRT Options Appointment, PD unit evaluation, catheter placement, and PD start). To explore the adequacy of catheter placement schedule, we compared the characteristics of the patients who started PD within 90 days of catheter placement (Early group), and of those who started after the first 90 days (Late group). We analyzed 48 patients in the Early and 27 in the Late group. The Early group presented a lower eGFR on KRT Options Appointment, with timely intervention: eGFR at catheter placement averaged 8.0 ± 2.1 mL/min/1,72m2. PD start occurred at 7.0 ± 1.9 and 8.0 ± 2.4 mL/min/1.72m2, in the Early and Late group, respectively. None of the patients suffered an urgent transition to HD by CVC. Four patients started PD less than 15 days after catheter placement, all of them without complications. PD patients’ admission involves specific tasks. Administrative tools or indicators to evaluate those processes are lacking. A peritoneal access clinic would allow the formalization of this circuit, allowing a quality and equitable approach to dialysis access. We suggest a structured pathway for peritoneal access management.