Does pre-dialysis assessment affect patients’ outcome on peritoneal dialysis (PD)?

Background There is substantial variation in peritonitis rates across peritoneal dialysis (PD) units globally. This may, in part, be related to the wide variability in patient selection and pre-dialysis assessment prior to commencement of home training. Aims This study aimed to evaluate whether performing a pre-dialysis assessment using a well validated assessment tool, JPAT (Jo-Pre-training Assessment Tool), before the patient commenced PD affected patient outcomes positively, and subsequently reduced PD-related complications. Study design This is a retrospective file audit of all incident patients who commenced PD at home from 1 July 2014 to 30 June 2016 in a metropolitan PD Unit in Sydney. Data collected included demographics, pre-dialysis assessment, JPAT score, peritonitis episodes and commencement date of PD. Local Ethics Committee approval was sought prior to commencing the study. Outcome measures included time to first peritonitis episode and length of time on PD. Results The medical records of 155 patients who commenced PD were collected. The results showed that there was no significant statistical difference (p=0.494 >0.05) for the onset of peritonitis between patients who received pre-dialysis education or had a JPAT attended and those that did not. Conclusion The use of a validated tool to assess patient suitability for PD to enhance patient outcomes has not been demonstrated in this study. The timing the JPAT was attended may have impacted on the outcome of the study as patient issues may have developed following assessment and prior to the commencement of dialysis.