Kidney Week

Abstract: PUB071

Peritoneal Dialysis at a County Hospital: Making It the Option, Not the Exception

Session Information

• Publication Only

Category: Dialysis

• 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

• Jameson, Robert L., Baylor College of Medicine, Houston, Texas, United States

Robert L. Jameson, MD

• Elkhidir, Sabri Elamin abbas, Baylor College of Medicine, Houston, Texas, United States

Sabri Elamin abbas Elkhidir, MD, MBBS

• De, Srijisnu, Baylor College of Medicine, Houston, Texas, United States

Srijisnu De, MD

• Win, Shwe Yee, Baylor College of Medicine, Houston, Texas, United States

Shwe Yee Win, MD

• Aguilar Bolona, Carlos Emilio, Baylor College of Medicine, Houston, Texas, United States

Carlos Emilio Aguilar Bolona, MD

• Worah, Parth, Baylor College of Medicine, Houston, Texas, United States

Parth Worah, DO

• Kassem, Hania, Baylor College of Medicine, Houston, Texas, United States

Hania Kassem, MD, FASN

Background

Peritoneal dialysis (PD) remains an underutilized option of treatment despite clinical, quality of life, and cost advantages. Current evidence supports a multidisciplinary approach to promote early and structured dialysis education to increase PD utilization. Barriers to PD use were limited provider familiarity, complex referral processes, and inconsistent documentation. Our aim was to increase patient education on PD by 20% among patients initiated on dialysis at our hospital between January and May 2026.

Methods

We conducted a retrospective review of all patients initiated on dialysis between January and June 2025, collecting demographics, etiology of kidney failure, documentation of PD counseling, the patient’s interest in PD, and the dialysis modality initiated. Pre-intervention surveys were administered to nephrology providers to assess knowledge, comfort level, and training in PD, as well as their perceived barriers to PD use.

A Plan–Do–Study–Act (PDSA) cycle was implemented that included: PD educational sessions for nephrology providers; PD workshops for nephrology fellows; increased fellows’ exposure to PD through program rotations; and standardized PD referral pathways. The primary outcome was the proportion of patients with documented PD education.

Results

Prior to our intervention, among 77 patients initiated on dialysis, PD counseling was documented in 43 patients (55%). Provider surveys revealed lower comfort levels with PD compared to hemodialysis and reported barriers including lack of support, referral complexity, and time required for education. Post intervention data is ongoing; thus far, 46 patients were initiated on dialysis within the time frame, with PD counseling occurring for 72% and of those, 30% expressed interest in PD.

Conclusion

PD underutilization at our hospital appears driven primarily by modifiable provider and system level barriers. Structured education for patients and providers represents actionable targets for improvement. Ongoing PDSA cycles aim to achieve sustained increases in documented PD education and PD initiation.