What is the importance of knowing about peritoneal dialysis (PD) in patient care?

The Importance of Knowing About Peritoneal Dialysis in Patient Care

Adequate knowledge about peritoneal dialysis (PD) is essential for healthcare providers to ensure optimal patient outcomes, as inadequate understanding of PD principles directly impacts patient survival, technique success, and quality of life.

Why PD Knowledge is Critical for Healthcare Providers

• Inadequate understanding of the physiology and kinetic principles of PD by physicians and nursing staff can lead to errors in patient selection, prescription of PD dose, monitoring of delivered dose, and inability to recognize patient noncompliance 1
• Nephrology fellowship curricula often lack emphasis on training in dialysis, highlighting the need for healthcare providers to ensure adequate education and training in PD 1
• Proper knowledge of PD allows for appropriate patient selection, identifying those who would benefit most from this modality versus hemodialysis 1
• Understanding PD principles enables healthcare providers to prescribe and deliver the proper dose of therapy, directly impacting patient survival 1

Impact on Patient Outcomes

• Suboptimal doses of delivered dialysis adversely affect patient survival in adults with end-stage renal disease (ESRD) 1
• PD technique survival (both dependent and independent of peritonitis) should be monitored as an outcome measure, requiring healthcare providers to understand factors affecting technique success 1
• Proper knowledge of PD allows for better management of patients with cardiovascular disease, as PD offers better hemodynamic control, less acute hypokalemia, and better control of anemia 1
• Understanding contraindications for PD (both absolute and relative) is crucial for appropriate patient selection and preventing complications 1

Role in Patient Education and Compliance

• Inadequate patient education, stemming from poor educator understanding of PD principles, is a key factor in patient nonadherence to prescribed therapy 1
• Staff responsible for patient education should be trained and competent in both the principles of clearance and the technique of patient instruction 1
• Proper explanations and patient participation in decision-making serve as good incentives for adherence to PD regimens 1
• Timely education about kidney failure treatment options, including PD, should begin when patients reach CKD stage 4 to allow for appropriate planning 1

PD as a Valuable Treatment Option

• PD has numerous potential advantages over hemodialysis, including greater patient autonomy, better preservation of residual renal function, and fewer dietary restrictions 2, 3
• PD may provide survival advantages over hemodialysis in the first 2-4 years of treatment 3, 4
• PD is less expensive than hemodialysis and may allow a larger number of ESRD patients to be treated 5, 4
• PD can be particularly beneficial for patients with cardiovascular disease due to better hemodynamic control 1

Preventing and Managing Complications

• Knowledge of PD principles is crucial for preventing and managing complications such as peritonitis, which remains the main cause of method failure 6
• Understanding how to preserve residual renal function is paramount to prolong survival outcomes in PD patients 3
• Healthcare providers should be aware of potential surgical complications of PD and their appropriate management 6
• Knowledge about encapsulating peritoneal sclerosis, a rare but serious complication of PD, is important for early recognition and management 6

Models of Care Delivery

• Various models of assisted PD exist globally, requiring healthcare providers to understand different approaches to PD delivery 1
• Different healthcare systems have implemented various support structures for PD patients, from community nurses to trained non-healthcare professionals 1
• Understanding these models helps in implementing the most appropriate approach based on individual patient needs and available resources 1

Common Pitfalls to Avoid

• Inadequate dialysis clearance is a significant factor worsening kidney disease progression in hospitalized patients 7
• Avoiding nephrotoxic drugs and limiting the use of radiocontrast agents is crucial in PD patients with residual renal function 3
• Failure to recognize and promptly treat infectious complications can lead to loss of peritoneal membrane function and even patient death 6
• Inadequate monitoring of delivered PD dose can result in suboptimal outcomes 1

Understanding peritoneal dialysis is not just beneficial but essential for healthcare providers to ensure optimal patient selection, appropriate prescription, adequate monitoring, and timely management of complications, all of which directly impact patient survival, technique success, and quality of life.