Talerngsak Kanjanabuch1,2,3, Pongpratch Puapatanakul1,3, Guttiga Halue4, Pichet Lorvinitnun5, Kittisak Tangjittrong6, Krit Pongpirul7,8, Surapong Narenpitak9, Chanchana Boonyakrai10, Sajja Tatiyanupanwong11, Rutchanee Chieochanthanakij12, Worapot Treamtrakanpon13, Uraiwan Parinyasiri14, Niwat Lounseng15, Phichit Songviriyavithaya16, Suchai Sritippayawan17, Jeffrey Perl18, Roberto Pecoits-Filho19,20, Bruce Robinson20, Simon J Davies21, David W Johnson22,23,24, Kriang Tungsanga. 1. Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 2. Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 3. Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. 4. Department of Medicine, Phayao Hospital, Thailand. 5. Department of Medicine, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand. 6. Division of Nephrology, Department of Internal Medicine, Phranangklao Hospital, Nonthaburi, Thailand. 7. Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 8. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 9. Renal Unit, Department of Internal Medicine, Udon Thani Hospital, Thailand. 10. Department of Medicine, Taksin Hospital, Bangkok Metropolitan Administration, Bangkok, Thailand. 11. Division of Nephrology, Department of Internal Medicine, Chaiyaphum Hospital, Thailand. 12. Dialysis Unit, Department of Medicine, Sawanpracharak Hospital, Nakhon Sawan, Thailand. 13. Department of Medicine, Chaopraya Abhaiphubejhr Hospital, Prachin Buri, Thailand. 14. Kidney Diseases Clinic, Department of Internal Medicines, Songkhla Hospital, Thailand. 15. Department of Medicine, Trang Hospital, Thailand. 16. Division of Nephrology, Department of Medicine, Amnat Charoen Hospital, Thailand. 17. Division of Nephrology, Department of Internal Medicine, Siriraj Hospital, Bangkok, Thailand. 18. Division of Nephrology, St. Michael's Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. 19. Pontifical Catholic University of Paraná, Curitiba, Brazil. 20. Arbor Research Collaborative for Health, Ann Arbor, MI, USA. 21. Faculty of Medicine and Health Sciences, Keele University, Keele, UK. 22. Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia. 23. Australasian Kidney Trials Network, Centre for Kidney Disease Research, University of Queensland, Brisbane, QLD, Australia. 24. Department of Kidney Research, Translational Research Institute, Woolloongabba, Australia.
Abstract
BACKGROUND: Despite the implementation of a 'Peritoneal Dialysis (PD) First' policy in Thailand since 2008, nationwide PD practices and patients' outcomes have rarely been reported. METHODS: As part of the multinational PD Outcomes and Practice Patterns Study (PDOPPS), PD patients from 22 PD centres from different geographic regions, sizes and affiliations, representing Thailand PD facilities, have been enrolled starting in May 2016. Demographic, clinical and laboratory data and patients' outcomes were prospectively collected and analysed. RESULTS: The pilot and implementation phases demonstrated excellent concordance between study data and validation data collected at enrolment. In the implementation phase, 848 PD patients (including 262 (31%) incident PD patients) were randomly sampled from 5090 patients in participating centres. Almost all participants (95%) performed continuous ambulatory PD (CAPD), and a high proportion had hypoalbuminemia (67%, serum albumin < 3.5 g/dL), anaemia (42%, haemoglobin <10 g/dL) and hypokalaemia (37%, serum potassium < 3.5 mmol/L). The peritonitis rate was 0.40 episodes/year, but the culture-negative rate was high (0.13 episodes/year, 28% of total episodes). The patients from PD clinics located in Bangkok metropolitan region had higher socio-economic status, more optimal nutritional markers, blood chemistries, haemoglobin level and lower peritonitis rates compared to the provincial regions, emphasizing the centre effect on key success factors in PD. CONCLUSIONS: Participation in the PDOPPS helps unveil the critical barriers to improving outcomes of PD patients in Thailand, including a high prevalence of hypokalaemia, anaemia, poor nutritional status and culture-negative peritonitis. These factors should be acted upon to formulate solutions and implement quality improvement on a national level.
BACKGROUND: Despite the implementation of a 'Peritoneal Dialysis (PD) First' policy in Thailand since 2008, nationwide PD practices and patients' outcomes have rarely been reported. METHODS: As part of the multinational PD Outcomes and Practice Patterns Study (PDOPPS), PD patients from 22 PD centres from different geographic regions, sizes and affiliations, representing Thailand PD facilities, have been enrolled starting in May 2016. Demographic, clinical and laboratory data and patients' outcomes were prospectively collected and analysed. RESULTS: The pilot and implementation phases demonstrated excellent concordance between study data and validation data collected at enrolment. In the implementation phase, 848 PD patients (including 262 (31%) incident PD patients) were randomly sampled from 5090 patients in participating centres. Almost all participants (95%) performed continuous ambulatory PD (CAPD), and a high proportion had hypoalbuminemia (67%, serum albumin < 3.5 g/dL), anaemia (42%, haemoglobin <10 g/dL) and hypokalaemia (37%, serum potassium < 3.5 mmol/L). The peritonitis rate was 0.40 episodes/year, but the culture-negative rate was high (0.13 episodes/year, 28% of total episodes). The patients from PD clinics located in Bangkok metropolitan region had higher socio-economic status, more optimal nutritional markers, blood chemistries, haemoglobin level and lower peritonitis rates compared to the provincial regions, emphasizing the centre effect on key success factors in PD. CONCLUSIONS: Participation in the PDOPPS helps unveil the critical barriers to improving outcomes of PD patients in Thailand, including a high prevalence of hypokalaemia, anaemia, poor nutritional status and culture-negative peritonitis. These factors should be acted upon to formulate solutions and implement quality improvement on a national level.