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Eligibility and patient barriers to peritoneal dialysis in patients with advanced chronic kidney disease
Saleem Abdulkarim1, Jasmit Shah1, Ahmed Twahir1
1Department of Internal Medicine, 58585Aga Khan University, Nairobi, Kenya.
Insights
Peritoneal dialysis (PD) eligibility in Kenya is high, with 68.9% of patients suitable. Support systems significantly improve PD uptake, overcoming common physical and surgical barriers for chronic kidney disease patients.
Area of Science:
- Nephrology
- Public Health
- Renal Replacement Therapy
Background:
- Chronic kidney disease (CKD) burden is rising in Kenya, necessitating renal replacement therapy.
- Hemodialysis (HD) is the predominant therapy, while peritoneal dialysis (PD) remains underutilized.
- Investigating barriers to PD uptake is crucial for patient care.
Purpose of the Study:
- To assess patient eligibility for peritoneal dialysis (PD) in Kenya.
- To identify contraindications and barriers limiting PD utilization.
- To determine the impact of support systems on PD eligibility.
Main Methods:
- Descriptive cross-sectional study assessing advanced CKD patients.
- Multidisciplinary team evaluation using a standardized PD eligibility tool.
- Recording contraindications, barriers, and support availability; demographic and clinical data collected.
Main Results:
- 68.9% of patients were eligible for PD.
- Surgery-related abdominal scarring was the most frequent contraindication.
- 45.9% faced barriers, predominantly physical over cognitive; support significantly increased eligibility (p < 0.001).
Conclusions:
- PD eligibility in Kenya mirrors global rates.
- Surgical factors and physical/cognitive barriers are key contraindications.
- Support systems are vital for overcoming barriers and enhancing PD adoption.
Introduction:
The burden of chronic kidney disease (CKD) is increasing in Kenya and is a significant cause of morbidity and mortality. While definitive treatment is renal transplantation, many patients require kidney replacement therapy with haemodialysis (HD) or peritoneal dialysis (PD). The predominant modality utilized in Kenya is currently HD. There is a need to explore why PD remains underutilized and whether patient factors may be contributory to barriers that limit the uptake of PD.
Methods:
This was a descriptive cross-sectional study where patients with advanced CKD were assessed by a multidisciplinary team for PD eligibility using a standardized tool. Contraindications and barriers to the modality were recorded as was the presence or absence of support for the provision of PD. Demographic and clinical data were recorded using a standardized questionnaire. The impact of support on PD eligibility was determined.
Results:
We found that 68.9% patients were eligible for PD. Surgery-related abdominal scarring was the most common contraindication. Barriers to PD were identified in 45.9% and physical barriers were more common than cognitive barriers. Presence of support was associated with a significant increase in PD eligibility (p < 0.001).
Conclusion:
The rate of eligibility for PD in this study was similar to that found in other populations. Surgical-related factors were the most commonly identified contraindication. Physical and cognitive barriers were commonly identified and may be overcome by the presence of support for PD.
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