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A Simple Protocol for Platelet-mediated Clumping of Plasmodium falciparum-infected Erythrocytes in a Resource Poor Setting
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Expanding CAPD in Low-Resource Settings: A Distance Learning Approach.

Robert Rope1, Nishantha Nanayakkara2, Abdul Wazil2

  • 1Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA roper@ohsu.edu.

Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis
|May 26, 2018
PubMed
Summary

A new educational program successfully expanded continuous ambulatory peritoneal dialysis (CAPD) in Sri Lanka, significantly reducing peritonitis rates. This initiative offers a model for supporting dialysis care in resource-limited settings.

Keywords:
Peritoneal dialysischronic kidney disease of unknown origincontinuous ambulatory peritoneal dialysislow- and middle-income countriesperitonitisquality improvement

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Area of Science:

  • Nephrology
  • Global Health
  • Medical Education

Background:

  • End-stage renal disease treatment is limited in low- and middle-income countries due to resource constraints.
  • Continuous ambulatory peritoneal dialysis (CAPD) offers a viable treatment option but requires specialized support.
  • Developing sustainable CAPD programs in resource-limited settings is crucial.

Purpose of the Study:

  • To describe the development of an educational curriculum and quality improvement program for CAPD in Sri Lanka.
  • To support non-nephrology providers in delivering CAPD care.
  • To evaluate the impact of the program on patient census and peritonitis rates.

Main Methods:

  • A comprehensive educational program including didactics, videos, and expert consultation was implemented.
  • An outcome-tracking system was established to monitor infections and hospitalizations.
  • Clinical cases and clinic management were reviewed in conferences.

Main Results:

  • The CAPD patient census increased from 63 to 116 within one year.
  • Peritonitis rates significantly decreased from 0.8 to 0.4 episodes per patient-year.
  • Appropriate culture data ascertainment and antibiotic prescription improved.

Conclusions:

  • The program successfully expanded CAPD services and improved patient outcomes in a resource-limited setting.
  • Challenges remain in provider education, outcome tracking, and protocol formalization.
  • This model can guide established dialysis programs in supporting resource-limited settings.