BACKGROUND: The central paradigm of effective peritoneal dialysis (PD) is an appropriate standard of PD catheter function. AIM: The aim of the project was to develop an effective national PD access audit which would identify an 'appropriate standard' of PD catheter function. METHODS: The UK Renal Registry collected centre specific information on various PD access outcome measures including catheter functionality and post-insertion complications. The first PD access audit covering England, Northern Ireland and Wales was conducted during April to June 2012 looking at incident dialysis patients in 2011. RESULTS: Forty three data collection spreadsheets were returned from a total of 65 centres describing 917 PD catheter placements. The median age of PD patients was 61 years and 61.5% were male. The proportion of patients initiated on PD in comparison to HD was lower in socially deprived areas. There was a relationship between the timing of nephrology referral and the likelihood of surgical assessment regarding PD catheter placement. Patients with diabetes did not have higher rates of PD catheter failure or of early peritonitis. CONCLUSIONS: A comparative PD catheter audit has the potential to provide valuable information on an important patient related outcome measure and lead to an improvement in patient experience. There was wide variation between centres of PD catheter use for late presenting patients. Overall patients were more likely to get a PD catheter if they had been known to the service for more than 1 year. The percutaneous insertion technique was associated with a higher early (less than 2 week) peritonitis rate and more catheter flow problems.
BACKGROUND: The central paradigm of effective peritoneal dialysis (PD) is an appropriate standard of PD catheter function. AIM: The aim of the project was to develop an effective national PD access audit which would identify an 'appropriate standard' of PD catheter function. METHODS: The UK Renal Registry collected centre specific information on various PD access outcome measures including catheter functionality and post-insertion complications. The first PD access audit covering England, Northern Ireland and Wales was conducted during April to June 2012 looking at incident dialysis patients in 2011. RESULTS: Forty three data collection spreadsheets were returned from a total of 65 centres describing 917 PD catheter placements. The median age of PDpatients was 61 years and 61.5% were male. The proportion of patients initiated on PD in comparison to HD was lower in socially deprived areas. There was a relationship between the timing of nephrology referral and the likelihood of surgical assessment regarding PD catheter placement. Patients with diabetes did not have higher rates of PD catheter failure or of early peritonitis. CONCLUSIONS: A comparative PD catheter audit has the potential to provide valuable information on an important patient related outcome measure and lead to an improvement in patient experience. There was wide variation between centres of PD catheter use for late presenting patients. Overall patients were more likely to get a PD catheter if they had been known to the service for more than 1 year. The percutaneous insertion technique was associated with a higher early (less than 2 week) peritonitis rate and more catheter flow problems.
Authors: Rishi Mandavia; Alec Knight; John Phillips; Elias Mossialos; Peter Littlejohns; Anne Schilder Journal: BMJ Open Date: 2017-09-24 Impact factor: 2.692