Association of nurse-patient ratios with outcomes in patients on peritoneal dialysis

Centre-related factors, in addition to patient-related factors, are known to influence the outcomes of patients on peritoneal dialysis (PD). It is unclear if the nursing staff-to-patient ratios at different PD centres affect peritonitis outcomes. Our study aimed to examine whether full-time equivalent (FTE) PD nurse-patient ratios in individual PD centres were associated with centre-level outcomes of patients on PD. We used a cross-sectional survey of nursing leads of PD units across Australia and multi-centre registry data linkage. Of the 38 PD units in Australia, 28 (73.7%) nursing leads responded to the survey. The overall FTE PD nurse-patient ratio was 1 nurse to 12.7 patients (median; interquartile range 9.8-16.5), with substantial variability between PD units. There was no significant association between the FTE PD nurse-patient ratios and unit-specific peritonitis rates, overnight hospitalisation rates for peritonitis, mortality rates within 30 days of infection, or haemodialysis (HD) transfer rates. However, there was a moderate positive correlation between nurse FTE and transfer to HD rates (r = 0.476, p < 0.01). While our study revealed large variability in FTE PD nurse-patient ratios between PD units across the country, it was not associated with clinically significant PD outcomes between centres. Therefore, PD nurse-patient ratios may not be an important centre-related factor to explain variability in clinically meaningful PD outcomes between centres.