Dr Aruni Malaweera1, Dr Louis Huang1, Professor Lawrence McMahon1
1Eastern Health, , Australia
Biography:
Aruni Malaweera is a PhD Fellow at Eastern Health
Aim:
To understand the current practice of peritoneal dialysis (PD) adequacy assessment in Australia and New Zealand.
Background:
Historically, PD adequacy has been determined by measuring small, water-soluble molecules including creatinine and urea. However, without evidence of a relationship to patient outcomes, recent guidelines have recommended focusing on patient reported outcomes measures (PROMs) instead. Whether such guidelines have changed clinical practice remains unknown.
Methods:
An anonymous online survey was distributed to nurses and doctors caring for PD patients through their respective Renal societies, to appraise centre and staff approaches to PD adequacy.
Results:
Eighty-seven clinicians responded to the survey, of whom 78% were Australian and 54% were doctors. Most had >10 years of nephrology experience. Of the respondents, 82% assessed dialysis adequacy using Kt/V and/or creatinine clearance (CCr) and patient symptoms, whereas 60% used a PROMs tool, namely IPOS and POS-S renal questionnaires. There was no difference between nursing and medical staff and for the minority who only assessed dialysis adequacy with patient symptoms, they were more likely from New Zealand (83% vs 17%). The majority favoured routine PD adequacy testing (47% yes and 21% maybe) for the following reasons: they (in addition to a PROM tool) provided a more comprehensive patient outlook; they quantified residual kidney function and ultrafiltration; they provided an opportunity for patients to raise financial or social concerns and allowed monitoring of these parameters longitudinally.
Conclusion:
Across Australia and New Zealand, there was no consistent method of assessing peritoneal dialysis adequacy. Most clinicians still rely on water-soluble measures of Kt/V and/or CCr, although a majority do use it in combination with a PROM tool.