Peritoneal dialysis: one unit's response to improving outcome and technique survival

Home therapies, including peritoneal dialysis (PD), empower self-management and enhance improved outcomes. Renal clinicians need to be promoting and encouraging home therapies, while providing the best possible education and support to ensure compliance and maintenance of modality of choice. Patients should be set up to succeed, with proactive management and ongoing individualised education from clinicians. A small Australian PD service identified several gaps in the current management of PD requiring a review of unit protocols including: patient selection and liaison with chronic kidney disease educator; aligned with current International Society of Peritoneal Dialysis (ISPD) guidelines; technique failure; patient education; and regular monitoring of infection rates.The unit sought to enhance PD outcomes through the implementation of strategic changes. These changes included: revision of PD protocols, discussions with microbiologists to reduce incidence of culture-negative peritonitis, improved communication between PD nurses and "on-call" nurses, state-wide networking, and the development of specific flow charts. The adoption of improved data collection methods and tracking of peritonitis rates further enhances outcomes by aiding the establishment of the root cause of infection, which, in turn, improves outcomes by reducing the risk of repeat episodes through focused education and prevention methods. Proactive management and ongoing individualised education, together with implemented changes as described, will result in better individual compliance, with increased support and, therefore, improved PD outcomes and technique survival time.