POS-668 BARRIERS AND OPPORTUNITIES TO INCREASE PD INCIDENCE AND PREVALENCE: LESSONS FROM A EUROPEAN SURVEY

Abstract

Peritoneal Dialysis (PD) remains underutilized despite the fact that outcomes have been demonstrated to be equal to hemodialysis (HD). Several barriers for PD growth have been identified, such as late referral, economic incentives, lack of training facilities or PD catheter placement issues. However, the potential interaction between all these mediators has not been explored, and they might be intertwined. The EuroPD™Future Leadership group* therefore performed a pan-European survey to identify potential barriers to growth of PD programs by exploring PD and home HD related practices and organizational aspects at centre level. In this abstract, we focus on the association between PD catheter placement policy, urgent (unplanned) start and education policy*EuroPD™FutureLeadership includes also Bechade C France; de Laforcade L France; Eden G Germany; Martin H,Germany; Steubl D,Germany; Wojtaszek E,Poland; Altabas K,Slovenia; Pajek J,Slovenia; Ros S,Spain; Vega A,Spain; Burkhalter F,Suisse; Allen J,UK; Corbett Richard,UK; Lambie M,UK An electronic survey was send to the contacts of EuroPD™ and to the members of regional societies of the members of the EuroPD Future Leadership initiative. In the survey, a virtual case vignette of a 48 year old woman not previously known to your unit who arrives at the emergency department with established end stage kidney disease was presented (late referral/unplanned start). We used chi-square tests and (ordinal) logistic regression to assess associations between modality choices for this case vignette and PD related practices, and also with % incident and prevalent patients on PD. We received 628 responses (317 academic, 243 non academic non private, 68 private; 67 with less than 50, 125 with 50-100, 243 with 100-220 and 193 with more than 200 patients). For the unplanned start case vignette, 32.6, 32.2 and 35.2% indicated they would start urgent PD, urgent HD or urgent HD with the plan to educate patient on PD at a later time respectively. Only 2 out of 3 respondents indicated that it was (very) likely this patient would receive education on PD in the unplanned setting. Urgent placement of a PD catheter (<48hours) was only possible in 32.4% of centres. In univariate analysis, choice for urgent start PD was associated with presence of a dedicated PD team, presence of a structured PD education program, the likelihood of an unplanned patient to receive education on PD, and having good relations with the PD access placement team, but not with centre size, %PD incidence or prevalence, financial issues, or the possibility to have a PD catheter placed within 48 hours. In a general linear mixed model, inclination to start PD in the case-vignette on unplanned start was only associated with presence of a dedicated PD team and the likelihood that the patient will receive education on homebased therapies. Percentage PD incidence and prevalence were only associated with presence of good education for both planned as for unplanned patients, and with a good relationship with the PD access team. Absence of a dedicated PD team seems to be the common denominator of already identified barriers to PD growth such as unplanned start and PD access placement issues. If we intend to grow PD programs, we will need to establish enthusiastic PD teams with good collaborations with dedicated PD catheter placement teams.