Dialysis adequacy assessment in peritoneal dialysis: A survey of current practice in Australia and New Zealand.

BACKGROUND

Dialysis adequacy measured by small solute clearance (e.g. urea and creatinine) have shown no correlation with patient outcomes so guidelines recommend focusing on patient reported outcome measures (PROMs) in addition to these traditional markers of dialysis adequacy. However, it is unknown whether this advice has translated into clinical practice in Australia and New Zealand.

METHODS

An anonymous online survey was distributed to clinicians caring for peritoneal dialysis (PD) patients through their respective nephrology societies, to appraise both centre-and staff-related approaches to PD adequacy.

RESULTS

Ninety-seven participants completed the survey, largely from Australia (n=79, 81%) and, specifically, Victoria (n=46, 48%). Most participants were consultant nephrologists (n=55, 57%) with more than 10 years' nephrology experience. The majority stated using a combination of traditional measures of dialysis adequacy (creatinine clearance and Kt/V) and assessment of PROMs (n=81, 84%). Most used a formal PROM tool assessment (n=58, 60%). The majority favored routine measurement of small solute clearance because it provided a more comprehensive patient outlook, including residual kidney function and ultrafiltration, and allowed an opportunity for patients to raise financial or social concerns that could be monitored longitudinally.

CONCLUSION

In Australia and New Zealand, most clinicians used a combination of numerical markers of dialysis adequacy and a PROM assessment. Regular measurement of small solute clearance was considered to have additional benefits of providing a more holistic appraisal of the patients progress and status. Further assessment of patients' perspective of regular assessments may provide useful insights to achieving a more person-centred approach in PD.