Changes in peritoneal dialysis practices in Canada 1996-1999

Area of Science:

• Nephrology
• Dialysis Therapy
• Clinical Practice Research

Background:

• Clinical studies and guidelines increasingly recommended higher small solute clearance targets for peritoneal dialysis (PD) patients.
• The study investigated whether these recommendations influenced actual PD prescription practices.

Purpose of the Study:

• To assess the impact of updated clinical guidelines on PD prescription patterns in Canada.
• To determine if PD prescriptions evolved towards higher clearance targets between 1996 and 1999.

Main Methods:

• Annual data from 1996-1999 on prevalent PD patients across 24 Canadian centers were analyzed.
• Prescription details (volumes, exchanges) and clearance values (Kt/V, creatinine) were recorded for continuous ambulatory PD (CAPD) and automated PD (APD).
• Prescription data were compared against contemporary treatment recommendations.

Main Results:

• Peritoneal dialysis (PD) prescriptions shifted towards higher volumes and more frequent exchanges for both CAPD and APD.
• The proportion of patients achieving recommended Kt/V (>2.0) and creatinine clearance (>60 L/week) increased significantly.
• Automated PD (APD) use doubled, and prescription volumes increased for both CAPD and APD patients.

Conclusions:

• Peritoneal dialysis (PD) prescription practices in Canada underwent significant changes in the late 1990s, driven by clinical evidence and guidelines.
• Improvements in PD prescription align with higher clearance targets, indicating successful guideline implementation.
• Further improvements are needed, particularly in ensuring regular clearance measurements for all PD patients.