Variances in peritoneal dialysis outcomes still exist

Abstract

Journal of Kidney CareVol. 1, No. 2 EditorialFree AccessVariances in peritoneal dialysis outcomes still existMark LambieMark LambieSearch for more papers by this authorMark LambiePublished Online:23 Jul 2016https://doi.org/10.12968/jokc.2016.1.2.56AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail Health professionals assisting with the provision of peritoneal dialysis (PD) have reason to be pleased with the clear improvements seen over time in mortality risk, reported by international registries (Australia and New Zealand Dialysis and Transplant Registry, 2016; Steenkamp et al, 2016; United States Renal Data System, 2015). These advances have come despite difficulties securing funding for meaningful, high-quality randomised controlled trials, and are likely to partially represent the ongoing drive to improve care through audit and quality improvement projects.One clinical area that leaps out as needing these measures is peritonitis, where there is clear evidence of marked variability between centres (Piraino et al, 2011). Although most UK units do run individual audits benchmarked against the target initially set for the first Renal Association guidelines in 1995 (<1 episode per 18 patient months), this represents a disappointing lack of progress, particularly when compared against international standards.The quote attributed to Irish mathematical physicist Lord Kelvin—‘If you cannot measure it, you cannot improve it’—highlights the need for data collection. For peritonitis, this has started to improve with summary data provided for the dashboard returns; however, to move from numerous local audits to one national audit, this needs to become registry data.Technique failure is another major issue for PD patients, as increasing evidence of significant between-centre variability suggests care should be improved. As this is a complex problem, with 39 separate possible reasons for variation (Perl et al, 2016), large studies are required. The Peritoneal Dialysis Outcomes and Practice Patterns Study will be the first to address this complex area. Nevertheless, to prevent patients unnecessarily switching to haemodialysis, registry data is again needed.In light of the aforementioned issues, the latest data requirements for the UK Renal Registry include details about peritonitis episodes and technique failure; however, this will only improve practice if information is added to the databases.To continue improving care for patients, and reduce local audit workload, PD teams need to ensure peritonitis and technique failure is routinely recorded.ReferencesAustralia and New Zealand Dialysis and Transplant Registry (2016) ANZDATA Registry. 38th Report, Chapter 5: Peritoneal Dialysis. http://tinyurl.com/ja5zd4e (accessed 13 July 2016) Google ScholarPerl J, Davies SJ, Lambie M et al. (2016) The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS): unifying efforts to inform practice and improve global outcomes in peritoneal dialysis. Perit Dial Int 36(3): 297–307 Google ScholarPiraino B, Bernardini J, Brown E et al. (2011) ISPD position statement on reducing the risks of peritoneal dialysis-related infections. Perit Dial Int 31(6): 614–30 Google ScholarSteenkamp R, Rao A, Fraser S (2016) UK Renal Registry 18th Annual Report (December 2015) Chapter 5: survival and causes of death in uk adult patients on renal replacement therapy in 2014: national and centre-specific analyses. Nephron 132(Suppl 1): 111–44 Google ScholarUnited States Renal Data System (2015) USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda: MD Google Scholar FiguresReferencesRelatedDetails 2 July 2016Volume 1Issue 2ISSN (print): 2397-9534ISSN (online): 2397-9542 Metrics History Published online 23 July 2016 Published in print 2 July 2016 Information© MA Healthcare LimitedPDF download