61 Urgent-start peritoneal dialysis and patient engagement: a chance for a new beginning of a smooth transition of peritoneal dialysis from hospital to outpatient centre

Background Drop-out from the Peritoneal dialysis (PD) Program impacts the service utilisation¹, with 35–50% of patients who initially started temporary hemodialysis (HD) through Permcath till the maturation of the Peritoneal dialysis catheter changing their mind and requesting permanent hemodialysis and peritoneal dialysis catheter removal before starting Peritoneal Dialysis training, we started an urgent-start peritoneal dialysis (USPD) program by keeping chronic kidney disease patients eligible to start PD through one peritoneal catheter without Permcath insertion and start PD 48 hours post-peritoneal catheter insertion.² The program‘s safety and efficacy were assessed through monitoring mechanical complications to reach our aims of reducing infection risk, establishing permanent PD access, and reducing hospitalization, increased PD utilisation and patient satisfaction.

Methods A multidisciplinary team triaged emergency and urgent need for PD, developed a clinical pathway for USPD, educate staff, referral to vascular surgeons for PD catheter insertion, then start PD 48 hours from insertion of PD catheter (figure 1). Sixteen patients were enrolled from October 2022 to June 2023, started on this new PD model.

Results After implementation of the new pathway, the percentage of USPD increased from 50% to 67% by June 2023 without any technical complications and switching to haemodialysis decreased from 35% to 8% by June 2023 (figure 2). All patients completed training without complications, and no longer required readmission for PD catheter removal if they changed their mind or Permcath removal.

Conclusion The transition to USPD was effective in reducing peritoneal dialysis drop-out, cost, and hospitalisation days, with improvements in patient experience.

References

1. Bittencourt Dias D, Mendes ML, Alves CA, Caramori JT, Ponce D. Peritoneal dialysis an urgent-start option for incident patients on chronic renal replacement therapy: world experience and review of literature. Blood purification 2020 Mar 6;49(6):652–7.DOI: 10.1159/000506505

2. Briggs V, Davies S, Wilkie M. International variations in peritoneal dialysis utilization and implications for practice. Am J Kidney Dis. 2019 Jul;74(1):101–110. doi: 10.1053/j.ajkd.2018.12.033. Epub 2019 Feb 22. PMID: 30799030.

Ethical Approval/IRB Statement The project was approved as Quality Improvement by the Dialysis Services Director.

Disclosures and Acknowledgments The authors have nothing to disclose.