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Peritoneal catheter insertion: combating barriers through policy change
Vivekanand Jha1,2,3, Alferso C Abrahams4, Abdullah Al-Hwiesh5
1George Institute for Global Health India, New Delhi, India.
Insights
Access to peritoneal dialysis (PD) catheter insertion is crucial for kidney failure patients. Improving PD access requires better patient selection, training, and policy changes to increase home dialysis uptake.
Area of Science:
- Nephrology
- Surgical Procedures
- Public Health Policy
Background:
- Home dialysis, particularly peritoneal dialysis (PD), is a vital option for kidney failure patients.
- The COVID-19 pandemic highlighted critical barriers to accessing PD catheter insertion, impacting patient survival.
- Timely access to PD catheter insertion procedures is essential for effective home dialysis therapy.
Purpose of the Study:
- To comprehensively analyze global PD catheter insertion procedures and identify access barriers.
- To assess the impact of the COVID-19 pandemic on PD catheter insertion capabilities and outcomes.
- To propose a roadmap of policy solutions to improve access to PD and home dialysis.
Main Methods:
- A global survey of institutions was conducted to gather data on regulatory frameworks, procedural barriers, and pandemic impacts.
- Analysis of current PD catheter insertion practices worldwide.
- Review of policy implications and potential solutions.
Main Results:
- Barriers to PD catheter insertion significantly limit home dialysis access, a critical issue exacerbated by the COVID-19 pandemic.
- Improving patient selection, insertion techniques, and multidisciplinary team collaboration enhances PD access.
- Global survey data reveals challenges in regulatory frameworks and pandemic-related disruptions.
Conclusions:
- Enhancing PD catheter insertion access requires optimizing patient selection, insertion techniques, and multidisciplinary care.
- Policy-level interventions, including increased awareness, enhanced training, and dedicated funding, are crucial for greater PD uptake.
- Strengthening the infrastructure and training for PD catheter insertion is vital to expand home dialysis options for kidney failure patients.
Abstract:
Barriers to accessing home dialysis became a matter of life and death for many patients with kidney failure during the coronavirus disease 2019 (COVID-19) pandemic. Peritoneal dialysis (PD) is the more commonly used home therapy option. This article provides a comprehensive analysis of PD catheter insertion procedures as performed around the world today, barriers impacting timely access to the procedure, the impact of COVID-19 and a roadmap of potential policy solutions. To substantiate the analysis, the article includes a survey of institutions across the world, with questions designed to get a sense of the regulatory frameworks, barriers to conducting the procedure and impacts of the pandemic on capability and outcomes. Based on our research, we found that improving patient selection processes, determining and implementing correct insertion techniques, creating multidisciplinary teams, providing appropriate training and sharing decision making among stakeholders will improve access to PD catheter insertion and facilitate greater uptake of home dialysis. Additionally, on a policy level, we recommend efforts to improve the awareness and feasibility of PD among patients and the healthcare workforce, enhance and promulgate training for clinicians-both surgical and medical-to insert PD catheters and fund personnel, pathways and physical facilities for PD catheter insertion.
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