POS-032 BARRIER TO AND CONSTRAINTS OF ACUTE PERITONEAL DIALYSIS IN ACUTE KIDNEY INJURY: A NATIONAL SURVEY

Abstract

Amidst the ever-increasing global burden of acute kidney injury (AKI), the ability to perform acute peritoneal dialysis (PD) is essential for many medical facilities. We, therefore, conducted a national survey to assess barriers and obstacles to acute PD usage in AKI to further promote the utility of PD in treating AKI cases. The national survey of practice patterns and obstacles in acute PD was performed by distributing an online questionnaire to all medical directors of public dialysis units registered with the Nephrology Society of Thailand during September-November, 2019. The barriers and constraints to performing acute PD were assessed using a 5-point Likert scale. Excluding duplicate responses, 113 adult facilities responded to the survey. Acute PD was performed in 66 centers (58%). In facilities where acute PD practice was available, the utilization rate was relatively low (<10 cases/year) and limited to specific conditions, including HIV seropositive patients, continuous kidney replacement therapy unavailability, and difficult vascular access creation. Only 9% of facilities performed acute PD routinely, but interestingly, all of such units permitted bedside catheter insertion by the nephrologists or internists. The major constraints placed on acute PD practice were PD catheter insertion competency, timely catheter insertion support, and knowledge/competency deficits of the medical supporting team. Clinical practice and patterns of acute PD in AKI were highly variable and deviated at times from the International Society for Peritoneal Dialysis (ISPD) guideline recommendations. Acute PD for AKI is underutilized in Thailand and limited by the inability to undertake timely PD catheter insertion and knowledge and competency deficits. Future research should focus on optimizing the safety and efficacy of improvized PD using readily available medical equipment in austere settings.