Improving the Outcomes of Peritoneal Dialysis Catheter Insertion

Individuals with kidney failure are responsible for up to 7% of health care expenditures in developed countries. Most patients are initially treated with home peritoneal dialysis (PD) or in-center hemodialysis. PD is felt to be equivalent to hemodialysis with respect to important clinical outcomes, is associated with significant cost savings, and is actively promoted. However, a well-functioning PD catheter is required to safely perform dialysis at home and we have observed that as many as 1 in 5 patients experience complications of their catheters that lead to invasive procedures or failure of therapy. Little is known about the patient-, operator-, and center-level factors that influence PD catheter outcomes. There is an urgent need to identify key modifiable practices to focus randomized trials and quality improvement efforts. We will leverage prior funding, a custom-built data collection platform, pilot data, and a group of engaged stakeholders, partners, and knowledge users to: 1) Determine if method of insertion is associated with mechanical, PD catheter complications; 2) Identify operator/center characteristics and practices associated with mechanical, PD catheter complications; 3) Use a data-driven approach to achieve expert consensus on optimal practices for PD catheter insertion and care. We have the necessary expertise, experience, and partners to successfully complete this project. We have made significant progress to date and seek the necessary funding to continue. Optimal practices will be implemented in participating centers and the impact will be evaluated in future work.