Improving technique survival in peritoneal dialysis: what is modifiable?

The continuous quality improvement approach in peritoneal dialysis practice necessitates definition of the factors and the procedures that may possibly be contributing to the final success of peritoneal dialysis. The philosophy of continuous quality improvement uses the Plan, Do, Check, Act (PDCA) cycle. To improve the procedures used during peritoneal dialysis, the first step is to create a plan, then to carry out the plan, to check it, and after the collection of satisfactory information, to execute the chosen improvement action. Several studies have identified the most frequent causes of transfer from PD to HD as infection, catheter problems, inadequate dialysis, and psychosocial factors, among others. According to training guidelines from the International Society for Peritoneal Dialysis, seven points are of major importance to decrease infection risks: exit-site care, catheter placement, antibiotic prophylaxis for procedures, prevention of bowel-source peritonitis, prevention of fungal peritonitis, and connection methods. On the other hand, other factors such as hypoalbuminemia, depression, and obesity should also be taken into consideration for better technique survival in peritoneal dialysis patients.