Development of an instrument to assess self-management capacity of patients receiving peritoneal dialysis: CAPABLE.

BACKGROUND: Treatment of kidney failure with peritoneal dialysis (PD) at home implies that the patient and/or their caregiver develop a series of skills and basic knowledge about this therapy. There is not a specific inventory of the patient's abilities to safely perform the PD procedure at home. The objective of this study was to describe the development of an instrument that allows measuring the self-management capacity of patients receiving PD, locating the performance areas that justify the need for intervention by a caregiver. METHODS: This is a qualitative study developed in three phases: The first phase was the identification of performance areas through bibliographic search and validation of the results with focus groups of experts in PD. The second phase was the design of a system to measure self-management capacities. The third phase was a pilot test of the preliminary version of the instrument applied in 20 incident PD patients. RESULTS: Three domains were identified to evaluate the fundamental components of self-management capacity: cognitive and sensory, each one evaluated with four items and motor domain evaluated with eight items. After applying the instrument, we found that 15 patients (75%) did not require support from the caregiver in any of the items. PD patients and nurses found the tool valuable, easy to understand and applicable in the early evaluation of a PD patient. CONCLUSIONS: We developed an easy-to-administer instrument to measure the self-management capacity of patients receiving PD. This inventory could locate areas that require specific support from a caregiver. Planning an individualised and focused education and training process could result in better health outcomes.

Early Peritonitis in a Large Peritoneal Dialysis Provider System in Colombia.

♦ BACKGROUND: Peritonitis is the most important complication of peritoneal dialysis (PD), and early peritonitis rate is predictive of the subsequent course on PD. Our aim was to calculate the early peritonitis rate and to identify characteristics and predisposing factors in a large nationwide PD provider network in Colombia. ♦ METHODS: This was a historical observational cohort study of all adult patients starting PD between January 1, 2012, and December 31, 2013, in 49 renal facilities in the Renal Therapy Services in Colombia. We studied the peritonitis rate in the first 90 days of treatment, its causative micro-organisms, its predictors and its variation with time on PD and between individual facilities. ♦ RESULTS: A total of 3,525 patients initiated PD, with 176 episodes of peritonitis during 752 patient-years of follow-up for a rate of 0.23 episodes per patient year equivalent to 1 every 52 months. In 41 of 49 units, the rate was better than 1 per 33 months, and in 45, it was better than 1 per 24 months. Peritonitis rates did not differ with age, ethnicity, socioeconomic status, or PD modality. We identified high incidence risk periods at 2 to 5 weeks after initiation of PD and again at 10 to 12 weeks. ♦ CONCLUSION: An excellent peritonitis rate was achieved across a large nationwide network. This occurred in the context of high nationwide PD utilization and despite high rates of socioeconomic deprivation. We propose that a key factor in achieving this was a standardized approach to management of patients.

Outcomes of a peritoneal dialysis program in remote communities within Colombia.

BACKGROUND AND OBJECTIVE: Colombia is a country of diverse geographic regions, some with mountainous terrain that can make access to urban areas difficult for individuals who live in remote areas. In 2005, a program was initiated to establish remote peritoneal dialysis (PD) centers in Colombia to improve access to PD for patients with end-stage renal disease who face geographic or financial access barriers. PATIENTS AND METHODS: The present study was a multi-center cohort observational study of prevalent home PD patients who were at least 18 years of age and were being managed by one of nine established remote PD centers in Colombia over a 2-year period. Data were collected from clinical records, databases, and patient interviews. Patient survival, incidence of peritonitis, and rate of withdrawal from PD therapy were assessed. RESULTS: A total of 345 patients were eligible for the study. The majority (87.8%) of patients lived on one to two times a minimum monthly salary (equivalent to US$243 - US$486). On average, patients traveled 1.2 hours and 4.3 hours from their home to their remote PD center or an urban reference renal clinic, respectively. The incidence rate of peritonitis was 2.54 episodes per 100 patient-months of therapy. A bivariate analysis showed a significantly higher risk of peritonitis in patients who were living on less than one times a monthly minimum salary (p < 0.05) or who had a dirt, cement, or unfinished wood floor (p < 0.05). The 1-year and 2-year patient survival rates were 92.44% and 81.55%, respectively. The 1-year and 2-year technique survival rates were 97.27% and 89.78%, respectively. CONCLUSIONS: With the support of remote PD centers that mitigate geographic and financial barriers to healthcare, home PD therapy is a safe and appropriate treatment option for patients who live in remote areas in Colombia.