Khoo Teck Puat Hospital1
Interventional nephrology (IN) does not have a well-defined role in peritoneal dialysis (PD) service provision. Impact on PD catheter outcomes, PD utilisation, and an integrated care approach under IN service was unknown. Here we report IN practice experience and outcomes in PD service from a single centre in Singapore.
We postulated an IN-led, multidisciplinary collaborative model of care for end-stage renal failure patients, who transited through a seamless care pathway from pre-dialysis counselling to insertion of PD catheter, could improve utilisation and increase uptake of PD as dialysis modality of choice. Our approach was based on 1. Interventional nephrologist-led PD catheter insertion service, 2. coordination of care and 3. early start of PD. In this study, we included the outcomes and safety of IN involvement in PD access management and care coordination.
From January 2015 to June 2020, a total of 201 PD catheter insertions were performed by interventional nephrologists. The prevalence of PD patients in our program was increased by 217% after initiation of IN service. Annually, incident ESRF patients who chose PD as dialysis modality increased from 14.5% (interquartile range 10.2%-20%) to 25.8% (20%-28.5%) (P=0.015). We had a very low PD catheter-related complication rate. Catheter adjustment-free survival was 95% and 94% at 12 months and 60 months, respectively.
The multi-faceted and holistic role of IN in PD translated into remarkable outcomes on PD utilisation and uptake. It also confirms the safety and efficacy of IN procedures in PD when performed by appropriately trained nephrologists.