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Abstract: FR-OR109

International PD Training Practices and the Risk of Peritonitis

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Perl, Jeffrey, St. Michael's Hospital, Toronto, Ontario, Canada
  • Fuller, Douglas S., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Boudville, Neil, University of Western Australia, Nedlands, Western Australia, Australia
  • Ito, Yasuhiko, Aichi Medical University, Nagakute, Aichi, Japan
  • Kanjanabuch, Talerngsak, Chulalongkorn University, Bangkok, Thailand
  • Piraino, Beth M., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Szeto, Cheuk-Chun, The Chinese University of Hong Kong, Shatin, Hong kong, China
  • Teitelbaum, Isaac, University of Colorado, Aurora, Colorado, United States
  • Woodrow, Graham, St James University Hospital, Leeds, United Kingdom
  • Johnson, David W., Princess Alexandra Hospital, Brisbane, Queensland, Australia
Background

Patient training for peritoneal dialysis (PD) is vital in reducing the risk of complications, including PD-related peritonitis. We describe variation in training practices across countries and assess their impact on peritonitis risk.

Methods

Using Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS; 2014-2017) data from Australia and New Zealand (A/NZ), Canada (CA), Japan (JP), Thailand (TH), the UK, and the US (non-large dialysis organization facilities), we report variation in facility-reported PD training practices and estimate associations with peritonitis using proportional rates models adjusted for patient and facility factors.

Results

183 out of 204 facilities with peritonitis data available returned a PDOPPS Unit Practices Survey (US, n=83; other, n=14-26). Nearly all facilities reported using unit-affiliated training nurses only (UK, 72%; other, >95%), a standard training curriculum (UK, 65%; JP, 79%; other, >90%), individualized training (TH, 41%; other, >88%) and a single nurse per patient (JP, 28%; A/NZ, 71%; other, >89%). All facilities required successful technique demonstration; 50% (US, 88%; other, 4-36%) required a written test, and 55% (CA, JP, UK, 24-40%; A/NZ, TH, US: 57-70%) required an oral test. Peritonitis rate was associated with the timing of training relative to catheter insertion (HR=1.12 [95% CI=0.87, 1.44], HR=1.34 [1.04, 1.72], and HR=1.47 [1.11, 1.96] for 1, 2, or 3 weeks after catheter insertion, respectively, vs. prior to insertion; p<0.01 for trend) and longer duration of training (HR=1.04 [0.86, 1.24] and HR=0.84 [0.69, 1.02] for 4-5 and ≥6 days, respectively, vs. 2-3 days; p=0.06 for trend).

Conclusion

Variation in PD training practices was seen across PDOPPS countries. Given the patient-centered nature of PD, earlier and longer training periods may reduce peritonitis risk.

Funding

  • NIDDK Support