What do we know about making peritoneal dialysis a success for our patients? How can we make this deceptively simple technique work better in practice? David Johnson enlightened the audience Wednesday afternoon regarding the remarkable variation in training practices in PD and how they relate to infections and technique failure, highlighting issues rarely considered such as the best techniques for adult learning, the importance of repetition in training, and the role of experience of the trainers. Program size—a challenge in many practices—is also an issue, with better outcomes at a critical number of patients.
Beth Piraino, filling in for Raj Mehotra, discussed planned transition to HD and the pros and cons of having a fistula ready and waiting for the day when a PD patient has to change modalities. This is particularly challenging when PD is chosen because the patient has poor veins or is not thought a good HD candidate at the outset, but there are certain situations where the ‘writing is on the wall’ for PD and planned transition is needed.
Joni Hansson discussed an enticing area which most of us do not do, mainly for logistical reasons—acute start PD. With the right surgical or interventional expertise, it is not only possible but sometimes preferable to go straight to PD. Certainly (in my experience at least) the inertia to start PD after urgent-start HD is very high, and usually many months of central venous catheter use go by before someone manages to schedule a PD catheter placement. With the right system and buy-in from all parties, patients starting renal replacement therapy in the hospital can go home to start PD—in the right cases, this is a great option and one we should work to make available.
Post written by Dr. Dena Rifkin, Feature Editor for AJKD’s In a Few Words.
Check out more eAJKD coverage of the NKF’s 2014 Spring Clinical Meetings!