Peritoneal Dialysis Penetration Research Articles

A Quality Improvement Process to Increase and Sustain a Peritoneal Dialysis Programme in the United Kingdom

Introduction: Peritoneal dialysis (PD) remains underutilised in the West. The proportion of patients in the UK starting renal replacement therapy (RRT) with PD fell from 7.2% in 2011 to 6.0% in 2016. At our centre, 8.4% of dialysis patients received PD in April 2014. Evidence suggests that home dialysis improves patient clinical outcomes; therefore, a target was agreed to achieve 25% of dialysis patients receiving PD by 2018. Methods: A rapid improvement process was introduced, as a quality improvement tool, to increase and sustain the PD programme. With multidisciplinary team support for PD growth, a nephrologist was trained to insert PD catheters. Nurses were trained to provide patients with balanced pre-dialysis information and discuss alternative dialysis modalities with haemodialysis (HD) patients. The “Acceptance, Choice and Empowerment” project raised awareness of home therapy choices, using a peer educator model specifically for ethnic minority patients. Lean methodologies were used to ensure continuous quality improvement. Results: PD uptake increased from 37 to 84 patients, giving a PD penetration increase from 8.4% to 19.1% between April 2014 and March 2018. Catheter insertions increased from 94 at the end of QI Period 1 to 185 at the end of QI Period 2, representing a 97% increase, with the medical/surgical split remaining stable. Peritonitis rates remained stable, and PD drop off to HD reduced from 52% to 41% during the same period. Conclusions: By implementing a rapid improvement process and embedding a quality improvement programme, the number of incidents and prevalent PD patients increased and was sustained.

POS-727 PERITONEOSCOPE VS SELDINGER PERITONEAL DIALYSIS CATHETER INSERTION- IS THERE A DIFFERENCE?

As the global burden of chronic kidney disease continues to increase, the importance of a cost-effective renal replacement therapy cannot be overlooked. Both peritoneal dialysis (PD) and haemodialysis (HD) have similar survival outcome with PD being more cost effective in developed countries. However PD is still underutilized around the world, including Malaysia; contributing only to 10% of overall renal replacement therapy in the country. We aim to compare both peritoneoscopic and seldinger catheter insertion technique that is being practised in our institution to increase PD penetration.

Renal Data from the Arab World Dialysis in Kuwait: 2013-2019.

The total number of end-stage kidney disease patients treated with dialysis in 2019 in Kuwait was 2230, with a 6% increase from the year before. Dialysis prevalence was 465 per million population (PMP) and dialysis incidence was100 PMP. Kuwaiti nationals represented 70% of the dialysis population and males represented 52%. Of the same population, 59% had diabetes. Hepatitis C virus affected <4% and hepatitis B virus affected <2% of the dialysis population. The annual mortality rate was stable at around 12%. Hemodialysis (HD) share was 89%, with 48% of HD patients getting HD via catheter, 54% on hemodiafiltration (HDF), and 50% dialyzing against a calcium bath of 1.75. Patients getting <3 times/week of HD constituted 10% and patients spending <3.5 h/session constituted 11%. We had only 20 dialysis patients under the age of 12 years (12 on HD). The major challenges faced included poor peritoneal dialysis penetration, the unacceptable high rates of catheters as primary HD vascular access, partly due to lack of chronic kidney disease (CKD) clinics and lack of vascular access coordinators, and the unexplained high rates of use of calcium bath of 1.75. There is also a need for a national campaign for early detection and prevention of CKD to reduce rates of end-stage renal disease.

PUK6 AN EVALUATION OF THE BRAZILIAN POLICY FOR THE MANAGEMENT OF CHRONIC KIDNEY DISEASE UNDER THE PERSPECTIVE OF THE PUBLIC HEALTH CARE SYSTEM: WAS IT EFFECTIVE?

To provide a comprehensive assessment of the Brazilian Chronic Kidney Disease management policy under the perspective of Brazil’s public health care system, identifying difficulties and effects based on other country-specific management policies. It is also hoped to contribute with the Brazilian public health care authorities, physicians and other decision-makers, aiming to improve patient-access to peritoneal dialysis (PD) through peritoneal dialysis-first and/or preferred policies. Data were collected from the Brazilian public health care system database to calculate number of patients on treatment per dialysis modality. The period between March 2013 and February 2014 was taken as baseline, representing the one-year period right before the policy implementation. Subsequent 12-month periods were then compared with the baseline showing the annual progressions. PD modality share was obtained by dividing the number of patients on PD therapy by the total number of patients on renal replacement therapy. A sub analysis was prepared for each of the five Brazilian geographic regions to illustrate possible discrepancies among them. The policy established that PD share should increase to achieve 20% by year 2 after its implementation, but results showed that the policy was not effective: a decrease from 7.0% to 6.0% of the PD share was observed after 4 years in the public system. The decrease in terms of PD share was observed in 4 of the 5 Brazilian geographic regions (more importantly in the North and Northeast). Policy failed in achieving the goal for PD penetration. Necessary measures and incentives were not implemented to support the objectives. Public policies in several countries were effective in overcoming barriers for the expansion of peritoneal dialysis and enhancing the access of their end of stage renal disease patients to treatment. Alternatives tested and well succeeded in other countries could serve as a benchmarking to the Brazilian public health care system.

Multidimensional analysis of factors responsible for the low prevalence of ambulatory peritoneal dialysis in Germany (MAU-PD): a cross-sectional Mixed-Methods Study Protocol

IntroductionPatients with end-stage kidney failure can be treated either by transplant or by dialysis, which can be administered as haemodialysis (HD) or peritoneal dialysis (PD). Although they are equivalent therapeutic...

Urgent start peritoneal dialysis.

Although historically peritoneal dialysis was widely used in nephrology, it has been underutilized in recent years. In this review, we present several key opportunities and strategies for revitalization of urgent start peritoneal dialysis use, and discuss the recent literature on clinical experience with peritoneal dialysis use in the acute and unplanned setting. Interest in using urgent start peritoneal dialysis to manage acute kidney injury (AKI) and unplanned chronic kidney disease (CKD) stage 5 patients has been increasing. To overcome some of the classic limitations of peritoneal dialysis use in AKI, such as a high chance of infectious and mechanical complications, and no control of urea, the use of cycles, flexible catheters, and a high volume of dialysis fluid has been proposed. This knowledge can be used in the case of an unplanned start on chronic peritoneal dialysis, and may be a tool to increase the peritoneal dialysis penetration rate among incident patients starting chronic dialysis therapy. Peritoneal dialysis should be offered in an unbiased way to all patients starting unplanned dialysis, and without contraindications to peritoneal dialysis. It may be a feasible, well tolerated, and complementary alternative to hemodialysis, not only in the chronic setting, but also in the acute.

Urgent Start Intermittent Peritoneal Dialysis Leads to Reduction of Catheter-Related Infection and Increased Peritoneal Dialysis Penetration

BackgroundNoncuffed catheters (NCC) are often used for incident hemodialysis (HD) patients without a functional vascular access. This, unfortunately results in frequent catheter-related complications such as infection, malfunction, vessel stenosis, and obstruction, leading to loss of permanent central venous access with superior vena cava obstruction. It is important to preserve central vein patency by reducing the number of internal jugular catheter insertions for incident HD patients with a functional vascular access. We sought to achieve this by introducing in-patient intermittent peritoneal dialysis (IPD) as bridging therapy while awaiting establishment of long-term vascular access for HD patients. MethodsIncident HD patients without permanent vascular access encountered from January to December 2014 were included in this study. Patients were divided into 2 groups: Group 1 were encountered within 6 months prior to introduction of in-patient IPD bridging therapy in substitution of noncuffed catheter (NCC) insertion while awaiting maturation of permanent vascular access. Group 2 were encountered within 6 months after the introduction of this policy. The number of NCC and peritoneal dialysiscatheter insertion, along with catheter-related infections were evaluated during this period. ResultsApproximately 450 patients were distributed in each group. We achieved 45% reduction in internal jugular catheter insertion from 322 to 180 catheters after policy change. This led to a significant drop in catheter-related blood stream infection (53%, P <0.001). On the other hand, 30% more peritoneal dialysiscatheter were inserted to accommodate our IPD bridging therapy. ConclusionsThe introduction of IPD as bridging therapy while awaiting maturation of permanent vascular access significantly reduced the utilization of NCC in incident HD patients and catherter-related blodstream infection. With this, it is our hope that it will contribute to the preservation of central vein patency.

"Why I Chose Hemodialysis Over Peritoneal Dialysis": An Opinion Survey Among In-Center Hemodialysis Patients.

Peritoneal dialysis (PD) penetration in India remains low despite the huge chronic kidney disease burden and unmet need for renal replacement therapy (RRT). In order to understand the socioeconomic reasons that govern patients' preference for hemodialysis (HD), we carried out an opinion survey among prevalent in-center HD patients at our institution using a multiple response questionnaire that was verbally administered to them at the dialysis facility by the investigators. Close to 80% were self-financed and 49.5% were on twice weekly HD. Despite the majority (95%) receiving RRT education from a nephrologist, 43.4% were not aware of PD as an RRT modality. The treating nephrologist's recommendation was the most important reason given for choosing HD (77.8%) and not choosing PD (69.7%). Other reasons for not choosing PD included lack of a dedicated caregiver or "clean area" at home (15.1%), fear of infection (15.1%), disruption of work (14.1%), and the high cost of PD (7%). The perceived advantages of HD over PD were greater convenience because of need for only twice or thrice weekly sessions (61%), supervised care received in a hospital setting (28.8%), and less disruption of the patient's and family's routine (22%). We discuss the implications of these findings and what policy makers and nephrologists in India and other developing countries can do to improve PD penetration and utilization.

Nephrologist-Initiated Peritoneal Dialysis Catheter Insertion Programme: A New Paradigm Shift.

The success rate of peritoneal dialysis (PD) catheter insertion is known to vary among different operators and may be influenced by many factors such as patient and various situational factors. Traditionally, surgeons have inserted Tenckhoff catheters by mini-laparotomy or an open technique. However, with recent advances in endoscopic instrumentation and video capabilities, peritoneoscope Tenckhoff catheter insertion has become a viable approach in interventional nephrologist-initiated PD access programmes. Nephrologist-initiated peritoneoscopic PD access programs have had a positive impact on PD penetration. The technique has been associated with a better primary success rate, superior catheter survival, less postoperative pain, shorter hospital stay, and shorter catheter break-in time compared with the conventional surgical technique. The role of interventional nephrologists in peritoneoscope Tenckhoff catheter placement is still perceived to be a relatively new advance, investigational by some, and many nephrologists and surgeons alike remain sceptical of the value of this recent option. Crucial questions often raised are how many procedures one needs to perform before being considered competent and who should be credentialed to perform the procedure or supervise trainees performing it. The evaluation of technical proficiency in a specific operation is difficult and complex. Cumulative summation (CUSUM) analysis is one option for tracking the success and failure of technical skill and examining trends over time. Key Messages: The author's facility has had good outcomes with a nephrologist-initiated peritoneoscopic PD access programme. Quality control of PD catheter insertion can be performed using CUSUM charting to monitor for primary catheter dysfunction, primary leak, and primary peritonitis.

Urgent Start Peritoneal Dialysis: A Viable Option for Acute and Chronic Kidney Failure

Peritoneal dialysis (PD) may be a feasible, safe, and complementary alternative to haemodialysis, not only in the chronic setting, but also in the acute. Recently, interest in using PD to manage acute kidney injury (AKI) patients has been increasing. Some Brazilian studies have shown that, with careful thought and planning, critically ill patients can be successfully treated with PD. To overcome some of the classic limitations of PD use in AKI, such as a high chance of infectious and mechanical complications, and no control of urea, potassium, and bicarbonate levels, the use of cycles, flexible catheters, and a high volume of dialysis fluid has been proposed. This knowledge can be used in the case of an unplanned start on chronic PD and may be a tool to increase the PD penetration rate among incident patients starting chronic dialysis therapy. PD should be offered in an unbiased way to all patients starting unplanned dialysis, and without contraindications to PD. In the following manuscript, advances in technical aspects and the advantages and limitations of PD will be discussed, and recent literature on clinical experience with PD use in the acute and unplanned setting will be reviewed.

Peritoneal dialysis can be an option for unplanned chronic dialysis: initial results from a developing country.

Starting dialysis in an unplanned manner is frequent situation in dialysis center even for patients with regular nephrology follow-up. Peritoneal dialysis (PD) appears as an option for unplanned initiation of chronic dialysis, offering the advantage of not using central venous catheters and preserving of residual renal function. Since July 2014, we have offered PD as urgent start for chronic kidney disease (CKD) patients. It was a prospective study that aimed to evaluate the mortality rate in hospitalized patients who started unplanned urgent PD in the first 90days. It was used high-volume PD right after (<48h) PD catheter placement, and it was kept until metabolic and fluid controls were achieved. After hospital discharge, patients were treated with intermittent PD on alternate days at the dialysis unit until family training. Thirty-five patients were included from July 2014 to January 2015. Age was 57.7±19.2years, diabetes was the main etiology of CKD (40.6%), and uremia was the main dialysis indication (54.3%). Metabolic and fluid controls were achieved after five sessions of high-volume PD, and patients remained in intermittent PD for 23.2±7.2days receiving 11.5±.3.1 intermittent PD sessions. Peritonitis and mechanical complications occurred in 14.2 and 25.7%, respectively. Mortality rate was 20%, and technique survival was 85.7%. The chronic PD program presented a growth of 41.1%. The concept of unplanned start on chronic PD may be feasible, safe, complementary alternative to hemodialysis and a tool to increase the PD penetration rate among incident patients starting dialysis therapy.

Peritoneal Dialysis in Western Countries

Background: Peritoneal dialysis (PD) for the treatment of end-stage renal failure was introduced in the 1960s. Nowadays it has evolved to an established therapy that is complementary to hemodialysis (HD), representing 11% of all patients treated worldwide with dialysis. Despite good clinical outcomes and similar results in patient survival between PD and HD, the penetration of PD is decreasing in the Western world. Summary: First the major events in the history of the development of PD are described. Then important insights into the physiology of peritoneal transport are discussed and linked to the changes in time observed in biopsies of the peritoneal membrane. Furthermore, the developments in peritoneal access, more biocompatible dialysate solutions, automated PD at home, the establishment of parameters for dialysis adequacy and strategies to prevent infectious complications are mentioned. Finally non-medical issues responsible for the declining penetration in the Western world are analyzed. Key Messages: Only after introduction of the concept of continuous ambulatory PD by Moncrief and Popovich has this treatment evolved in time to a renal replacement therapy. Of all structures present in the peritoneal membrane, the capillary endothelium offers the rate-limiting hindrance for solute and water transport for the diffusive and convective transport of solutes and osmosis. The functional and anatomical changes in the peritoneal membrane in time can be monitored by the peritoneal equilibrium test. Peritonitis incidence decreased by introduction of the Y-set and prophylaxis using mupirocin on the exit site. The decrease in the proportion of patients treated with PD in the Western world can be explained by non-medical issues such as inadequate predialysis patient education, physician experience and training, ease of HD initiation, overcapacity of in-center HD, lack of adequate infrastructure for PD treatment, costs and reimbursement issues of the treatment. Facts from East and West: (1) PD is cheaper than HD and provides a better quality of life worldwide, but its prevalence is significantly lower than that of HD in all countries, with the exception of Hong Kong. Allowing reimbursement of PD but not HD has permitted to increase the use of PD over HD in many Asian countries like Hong Kong, Vietnam, Taiwan, Thailand, as well as in New Zealand and Australia over the last years. In the Western world, however, HD is still promoted, and the proportion of patients treated with PD decreases. Japan remains an exception in Asia where PD penetration is very low. Lack of adequate education of practitioners and information of patients might as well be reasons for the low penetration of PD in both the East and West. (2) Patient survival of PD varies between and within countries but is globally similar to HD. (3) Peritonitis remains the main cause of morbidity in PD patients. South Asian countries face specific issues such as high tuberculosis and mycobacterial infections, which are rare in developed Asian and Western countries. The infection rate is affected by climatic and socio-economic factors and is higher in hot, humid and rural areas. (4) Nevertheless, the promotion of a PD-first policy might be beneficial particularly for remote populations in emerging countries where the end-stage renal disease rate is increasing dramatically.

Peritoneal Dialysis in Asia

Background: There is a growing demand of dialysis in Asia for end-stage renal failure patients. Diabetes mellitus is the leading cause of end-stage renal failure in many countries in Asia. Summary: The growth of peritoneal dialysis (PD) in Asia is significant and seeing a good trend. With the enhanced practices of PD, the quality of care in PD in Asia is also improved. Overall, PD and hemodialysis (HD) are comparable in clinical outcome. There is a global trend in the reduction of peritonitis rates and Asian countries also witness such improvement. The socio-economic benefits of PD for end-stage renal failure patients in both urban and rural areas in the developed and developing regions of Asia are an important consideration. This can help to reduce the financial burden of renal failure in addressing the growing demand of patients on dialysis. Initiatives should be considered to further drive down the cost of PD in Asia. Key Messages: Growing demand for dialysis by an increasing number of end-stage renal failure patients requires the use of a cost-effective quality dialysis modality. PD is found to be comparable to HD in outcome and quality. In most countries in Asia, PD should be more cost-effective than HD. A ‘PD-first' or a ‘PD as first considered therapy' policy can be an overall strategy in many countries in Asia in managing renal failure patients, taking the examples of Hong Kong and Thailand. Facts from East and West: (1) PD is cheaper than HD and provides a better quality of life worldwide, but its prevalence is significantly lower than that of HD in all countries, with the exception of Hong Kong. Allowing reimbursement of PD but not HD has permitted to increase the use of PD over HD in many Asian countries like Hong Kong, Vietnam, Taiwan, Thailand, as well as in New Zealand and Australia over the last years. In the Western world, however, HD is still promoted, and the proportion of patients treated with PD decreases. Japan remains an exception in Asia where PD penetration is very low. Lack of adequate education of practitioners and information of patients might as well be reasons for the low penetration of PD in both the East and West. (2) Patient survival of PD varies between and within countries but is globally similar to HD. (3) Peritonitis remains the main cause of morbidity in PD patients. South Asian countries face specific issues such as high tuberculosis and mycobacterial infections, which are rare in developed Asian and Western countries. The infection rate is affected by climatic and socio-economic factors and is higher in hot, humid and rural areas. (4) Nevertheless, the promotion of a PD-first policy might be beneficial particularly for remote populations in emerging countries where the end-stage renal disease rate is increasing dramatically.

Peritoneal dialysis in China.

According to a recent cross-sectional survey of a nationally representative sample of 50,550 Chinese adults, the prevalence of chronic kidney disease (CKD) is as high as 10.8% and has become an important public health problem. Around 119.5 million adults (aged 18 years or older) have CKD (1) and might need dialysis at some point in their life. This will create a heavy burden on the Chinese social insurance system as well as patients' families. It was reported that 16% of patients withdrew from dialysis because of financial stress in 1999 (2). In the past decade, the dialysis population has begun to increase sharply, following the implementation of improved reimbursement policies. According to the Chinese Society of Nephrology, the total number of dialysis patients exceeded 258,000 by mid-2012. This represents more than double the number reported in the national survey undertaken in 2007-2008 when there were 102,863 dialysis patients, in 27 out of 31 provinces (3). There were only 41,755 dialysis patients at the end of 1999 in China (2). Of note, peritoneal dialysis (PD) utilization has increased even faster than hemodialysis, with 40,000 patients (estimated by Baxter Healthcare) at the end of 2012, which represents nearly a 10-fold increase since 2000 (2) (Figure 1). Peritoneal dialysis penetration thus increased from 8.6% in 2000 to 15.5% in 2012. At the same time, the number of PD centers has also increased from less than 10 to more than 700 (estimated by Baxter Healthcare). Figure 1 — Increasing trend of total dialysis and PD population in China between 2000-2012 (1-3). PD = peritoneal dialysis. All patients are currently using traditional glucose solutions with an average dose of 7.8 L/d (4) and most (> 99%) are on manual dialysis (such as continuous ambulatory peritoneal dialysis or daytime ambulatory peritoneal dialysis). Automated peritoneal dialysis (APD), is not reimbursed, and as such is underutilized. Nevertheless, PD quality has consistently improved. In 1999, 30% of patients achieved a Kt/V less than 1.5 with an average of 1.7 and 50% of patients remained on PD for less than 1 year with very few (< 5%) remaining longer than 5 years (2). Based on the 2012 Shanghai Dialysis Registry's Annual Report (5), the average Kt/V has been increased to 1.96, and 47% (1,177/2,503), and 22% (564/2,503) of patients have been on PD for at least 3 and 5 years, respectively. In another recent study which selected 9 centers from the largest dialysis facilities in 6 cities, the average Kt/V was as high as 2.1, with 11.5% of patients on PD for 5 years (6). Approximately two-thirds of PD patients are from large cities on the east coast of China, with the remaining third located in central China. Less than 5% of patients reside in western China, which is considered a remote area. Those residing within the east and large city centers have greater access to affordable healthcare, while those living within the remote areas tend to be less able to afford or access chronic dialysis or healthcare. In contrast, based on the cross-sectional survey (1), the prevalence of CKD is significantly higher in the southwest and the north, which may be due to high sodium intake and low birth weight, two known factors associated with increased risk of CKD. Since these areas have relatively low PD penetration, greater effort is required to support this expanding population in remote areas, where the risk and therefore the increase in demand for dialysis are highest. The provision of intensive PD training and education of the local healthcare professionals, for example, would be a start. Changes to reimbursement policies will improve access to dialysis and improve health-related outcomes. A recently initiated program, named Flying Angel, is an example of efforts made by both the Chinese government and the PD industry. Overcoming the barriers of using PD, “awareness, affordability, and access,” is the goal of this partnership, which aims to deliver sustainable PD care to uremic patients living in rural China. Hopefully, this will help China find a way to cover more uremic patients from rural areas who need dialysis and have limited resources, and provide an opportunity to grow and sustain PD in China.

Esiste un cutoff alla penetranza della dialisi peritoneale? Come superarlo?

Il centro di Brescia ha un'incidenza della DP del 35% e oltre 30 anni di esperienza. Nonostante ciò, ha un cutoff di prevalenza a 80 pazienti, che non riesce a superare. Questo breve scritto sintetizza alcune possibili soluzioni per incrementare l'utilizzo della DP.

Does penetration of peritoneal dialysis have a cutoff? How to overcome it?

At the dialysis center of Brescia, with experience in peritoneal dialysis (PD) of more than 30 years, the incidence of PD is 35%. Despite this, the prevalence of PD has an apparently fixed cutoff at about 80 patients. This short paper synthesizes some possible solutions to increase penetration of PD.

The low penetration of peritoneal dialysis in Italy

The low penetration of peritoneal dialysis (PD) in Italy is determined by multiple factors, among which the lack of acceptance of this dialysis method by many nephrologists, as well as the large number of centers with few PD patients, which do not allow for the creation of a competent experience. Not less importantly, there is a lack of planning and guidance by the institutions.

How to explain the low penetration of peritoneal dialysis in Brazil

The prevalence of patients initiating dialysis in Brazil increased in recent years - having doubled in the last decade, and it has become a major public health problem. 1 Peritoneal dialysis (PD) is an important form of treatment for patients with late stage chronic kidney failure requiring renal replacement therapy; however, the percentage of patients treated with PD is still low in Europe, ranging from 4% in Austria, Norway and parts of Spain, all the way to 11% in Denmark and Romania, but higher in the United Kingdom. 1,2 In Brazil, according to the Dialysis Census of the Brazilian Society of Nephrology - 2013, the number of patients on peritoneal dialysis is estimated at only 9.2%. 1 Therefore, how can we explain this low penetration of PD in Brazil, considering that the clinical results obtained from PD in terms of patient survival are even better than those obtained from hemodialysis (HD) in the early years of the program? 2,3 One aspect that may partially explain the underutilization of PD in Brazil is the low profit margin for dialysis units with this mode of renal replacement therapy when compared to that obtained from HD. This phenomenon is also observed in other countries of the world. 4,5 Moreover, there is no established fee to collect from the National Healthcare System - the main funding agency of dialysis in Brazil - for the costs associated with peritonitis episodes which is an important PD complication, though less frequent, and still an important technique for reducing the technical survival of the PD method.

Dialisi Peritoneale: Dialisi Marginale? 2013 Tentativo Di Sintesi Delle Opinioni a Confronto

Summary of the opinions expressed by Italian experts in the last special issue of this journal dedicated to the question of whether peritoneal dialysis (PD) is still marginal. The PD rate in Italy is stably around 10%, due to the frequently inadequate training of Nephrologists, poor organization of the Nephrology units, low reimbursements, regulatory gaps, and the existence of many private centers not authorized to use PD. Other factors that hinder PD penetration are the increasing number of frail elderly patients starting dialysis, and the risk of sclerosing peritonitis, at least in the long run. The need for good quality pre-dialysis education and further progress of research are here strongly emphasized.

Multicenter Analysis on the Impact of Nephrologist‐Initiated Catheter Insertion Program on Peritoneal Dialysis Penetration

The demands for timely catheter insertion have spurred the growth of peritoneoscopic catheter insertion program by nephrologists in Malaysia. We performed a multicenter analysis to study its impact on the growth of peritoneal dialysis (PD) population. Data were collected retrospectively from five centers at the point of program initiation until December 2009. In Center 1, with this program, PD population continued to grow from 25 patients in 2006 to 120 in 2009. In center 2, the program began in 2005, but comprised only 28.6% of total insertions. From 2007 onwards, nephrologists had overtaken the surgeon, inserting from 85% to 97% of the total insertions. In center 3, with the program at its infancy, a modest growth in its PD population was shown. In center 4, nephrologists maintained an annual average of 41.8% of total catheter insertions, and thus maintaining a stable PD population. In center 5, surgeon-assisted PD catheter insertions helped to maintain the growth of its PD, seeing lesser impact from this program. Subanalysis showed that 1-year catheter survival in Center 1 was 85.4%. This study on PD catheter insertion program by nephrologists showed the greatest impact on new center and center experiencing suboptimal catheter insertions by traditional providers.