Melissa S Cheetham1,2,3, Junhui Zhao4, Keith McCullough4, Douglas S Fuller4, Yeoungjee Cho5,6,7, Rathika Krishnasamy1,2, Neil Boudville8,9, Ana E Figueiredo10, Yasuhiko Ito11, Talerngsak Kanjanabuch12, Jeffrey Perl4,13, Beth M Piraino14, Ronald L Pisoni4, Cheuk C Szeto15, Isaac Teitelbaum16, Graham Woodrow17, David W Johnson5,6,7. 1. Department of Nephrology, Sunshine Coast University Hospital, Birtinya, QLD, Australia. 2. Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. 3. Sunshine Coast Health Institute, Birtinya, QLD, Australia. 4. Arbor Research Collaborative for Health, Ann Arbor, MI, USA. 5. Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia. 6. Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia. 7. Translational Research Institute, Brisbane, QLD, Australia. 8. Department of Nephrology, Sir Charles Gairdner Hospital, Perth, WA, Australia. 9. Medical School, University of Western Australia, Perth, WA, Australia. 10. School of Health Sciences and Life, Nursing School, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil. 11. Aichi Medical University, Nagakute, Japan. 12. Division of Nephrology, Department of Medicine and Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 13. St Michael's Hospital, Toronto, ON, Canada. 14. University of Pittsburgh, Pittsburgh, PA, USA. 15. Chinese University of Hong Kong, Shatin, Hong Kong, China. 16. University of Colorado, Aurora, CO, USA. 17. Renal Unit, St James's University Hospital, Leeds, UK.
Abstract
BACKGROUND: The effects of training practices on outcomes of patients receiving peritoneal dialysis (PD) are poorly understood and there is a lack of evidence informing best training practices. This prospective cohort study aims to describe and compare international PD training practices and their association with peritonitis. METHODS: Adult patients on PD <3 months participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) were included. Training characteristics (including duration, location, nurse affiliation, modality, training of family members, use of individual/group training and use of written/oral competency assessments) were reported at patient and facility levels. The hazard ratio (HR) for time to first peritonitis was estimated using Cox models, adjusted for selected patient and facility case-mix variables. RESULTS: A total of 1376 PD patients from 120 facilities across seven countries were included. Training was most commonly performed at the facility (81%) by facility-affiliated nurses (87%) in a 1:1 setting (79%). In the UK, being trained by both facility and third-party nurses was associated with a reduced peritonitis risk [adjusted HR 0.31 (95% confidence interval 0.15-0.62) versus facility nurses only]. However, this training practice was utilized in only 5 of 14 UK facilities. No other training characteristics were convincingly associated with peritonitis risk. CONCLUSIONS: There was no evidence to support that peritonitis risk was associated with when, where, how or how long PD patients are trained.
BACKGROUND: The effects of training practices on outcomes of patients receiving peritoneal dialysis (PD) are poorly understood and there is a lack of evidence informing best training practices. This prospective cohort study aims to describe and compare international PD training practices and their association with peritonitis. METHODS: Adult patients on PD <3 months participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) were included. Training characteristics (including duration, location, nurse affiliation, modality, training of family members, use of individual/group training and use of written/oral competency assessments) were reported at patient and facility levels. The hazard ratio (HR) for time to first peritonitis was estimated using Cox models, adjusted for selected patient and facility case-mix variables. RESULTS: A total of 1376 PD patients from 120 facilities across seven countries were included. Training was most commonly performed at the facility (81%) by facility-affiliated nurses (87%) in a 1:1 setting (79%). In the UK, being trained by both facility and third-party nurses was associated with a reduced peritonitis risk [adjusted HR 0.31 (95% confidence interval 0.15-0.62) versus facility nurses only]. However, this training practice was utilized in only 5 of 14 UK facilities. No other training characteristics were convincingly associated with peritonitis risk. CONCLUSIONS: There was no evidence to support that peritonitis risk was associated with when, where, how or how long PD patients are trained.