Identifying, educating patients are essential to successful peritoneal dialysis programs
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Beginning or growing a peritoneal dialysis program requires knowledgeable staff who can reach as many potential patient candidates as possible, according to a speaker at ASN Kidney Week.
“A successful PD program is a program that can offer PD to the widest possible range of patients and not only can a successful program offer PD to these patients, but it can maintain these patients on PD to maximally realize their goals of care,” Brendan McCormick, MD, FRCPC, associate professor at the University of Ottawa and medical director of home dialysis at the Ottawa Hospital, said during the meeting, which was held as a virtual event.
Nephrologists, nurses and other health care team members can most easily identify potential candidates in chronic kidney disease programs, but it is important to avoid overlooking patients in the hospital, McCormick said.
Educating potential candidates is a key component. Effective education requires knowledgeable staff and precise execution, according to McCormick. “You need to rapidly mobilize educational resources – and by rapid, I mean within half a day,” he said.
“You need to get an educator up there who can meet with the patient, talk with them and explain what [peritoneal dialysis] PD is, and then you need to have rapid PD catheter insertion.”
Educators can be nephrologists available to consult and recommend potential candidates or a nurse educator who follows patients. Regardless of who assumes the responsibility, it is important they are consistently available.
“You have to have an accessible dialysis education program,” McCormick said. “You have to have people who are skilled at teaching about options and taking a patient-centered approach to help them with their decision-making.”
Education can also help break down some of the barriers to peritoneal dialysis. Aside from those presented by clinical contraindications, McCormick said that regarding barriers, “These are almost all surmountable.
“More often, the issue that we need to address are these barriers that the patient may not have sufficient strength, dexterity, vision, et cetera, to perform the PD exchanges themselves or there may be a cognitive barrier.”
Nonetheless, it is health care policy, not patient ability, that determines the exigence of these barriers. According to McCormick, “in many parts of the world, assisted PD is funded.
“Assisted PD essentially means that somebody goes into the patient’s home and assists them with their exchanges.”
There are numerous advantages to community-based, patient-centered care, McCormick said. “Home visits are important: and that is to say, you need to get the nurse into the home to understand what’s going on in the home and to have to have a full understanding of what this patient’s challenges may be.”
One way to leverage the home visit with a nurse, who assesses vital signs and the exit site, is to set up a video call for the patient to be evaluated by a nephrologist, dietician and social worker.
“The increasing ability of cyclic connectivity can allow you to get information that you previously could only get from a home visit,” McCormick said.
Ideally, both patients and health care facilities benefit from peritoneal dialysis.
“If I’m seeing a high incidence of patients choosing PD, low peritonitis rates, low technique failure rates [and]a high prevalence of patients overall on peritoneal dialysis, [this] results in a growing program size and a strong reputation of the program both locally and provincially,” McCormick said, which “leads to what I refer to as the virtuous cycle of PD growth, where PD is encouraged in the [chronic kidney disease] CKD clinic because it’s felt to be a successful modality.”
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McCormick B. Peritoneal dialysis: Key ingredients to setting up a successful program. Presented at: ASN Kidney Week. Oct. 22-25, 2020 (virtual meeting).
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