Kidney Week

Abstract: TH-PO311

Impact of a Renal Quality Program in the Peritonitis Rate in a Dominican Republic Continuous Ambulatory Peritoneal Dialysis Program

Session Information

• Peritoneal Dialysis: CVD, Fluid, Nutrition
  November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 703 Dialysis: Peritoneal Dialysis

Authors

• Campos, Erwin I., Macrotech, Santo Domingo, Distrito Nacional, Dominican Republic

Erwin I. Campos,

• Collado, Jhanna H., Macrotech, Santo Domingo, Distrito Nacional, Dominican Republic

Jhanna H. Collado,

• Polanco, Elianny S., Macrotech, Santo Domingo, Distrito Nacional, Dominican Republic

Elianny S. Polanco,

• Aquey, Mercedes, Macrotech, Santo Domingo, Distrito Nacional, Dominican Republic

Mercedes Aquey,

• Ramos, Alfonso, Baxter Mexico, San Andres Ocotlan, Mexico

Alfonso Ramos,

• Guzman Chavez, Janny, Baxter Healthcare, Bogota, Colombia

Janny Guzman Chavez,

Background

Peritonitis is a frequent complication in the management of peritoneal dialysis (PD), is one of the main cause of hemodialysis transfer with direct impact on a patient’s quality of life and healthcare related costs. Also associated with loss of Residual Renal Function, peritoneal sclerosis and adequacy problems (1). Recently, the ISPD Guidelines recommends that regular monitoring of infections associated with peritoneal access should be part of the Continuous Quality Improvement program (CQI). The applications of these programs have shown an impact not only on the reduction of peritonitis events but also an improvement in patients and technique survival.

Methods

In 2015, a CQI program was implemented in 7 PD centers in the Dominican Republic. Lack of structured training and retraining program, home-visit and peritonitis treatment protocols, absence of local scientific committees, lack of standardized registries and key performance indicators were identified as the main problems. After this analysis, nurse activities were defined; structured training and retraining program, home-visit and peritonitis treatment protocols were implemented, a standardized registry was developed, and quality indicators were defined. A multicenter retrospective longitudinal analysis was performed on peritonitis events and outcomes between January 1st, 2015 to December 31st, 2018 were recorded. All patients were in CAPD and used Ultrabag system during all study period. Peritonitis was diagnosed according to the ISPD criteria. A two-time period was considered for technique and patient survival: 1^st, 2015-2016 and 2^nd, 2017-2018.

Results

During the study period, a total of 1801 patients were analyzed. The mean age was 57+ 17 years, 65% were male, diabetes (48%) was the main cause of kidney disease. The median peritonitis rate for 2015: 0.8, 2016: 0.20, 2017: 0.14, 2018 0.12 year at risk, the percentage of patients free of peritonitis were: 75% in 2015, 95% in 2016, 90% in 2017 and 96% in 2018. Cure response rate was: 2015: 63%, 2016 83%, 2017: 90%, 2018: 92%. The mean technique survival was 331 days in period 1 vs 399 d in period 2 p <0.0001.

Conclusion

The use of CQI has proven to be an effective tool to reduce peritonitis in Dominican Republic PD program and improve technical and patient survival.

Funding

• Commercial Support –