Introduction
Since Covid-19 disease had been declared as a pandemic in February 2020, it has affected much on our health care system especially with admission crisis due to not enough bed available for admission. Furthermore, congested environment in the hospital also increases patients' exposure risk to covid-19 disease. Traditionally, continuous ambulatory peritoneal dialysis (CAPD) patients who underwent training will be admitted to hospital for 3-5 days. Because of the pandemic, home peritoneal dialysis (PD) training programme was implemented. However, infectious complication was one of our major concerns.
Methods
This is a single centre, observational, retrospective study. We recruited patients who were newly enrolled into the peritoneal dialysis programme from January 2020 until March 2021 and each of them was follow up for 6 months duration. Patients’ demographic data, baseline characteristic, clinical outcome such as peritonitis rate, exit site infection were collected through electronic health record (eHIS) and data were analysed using SPSS version 23.
Results
A total of 133 patients were newly enrolled into the peritoneal dialysis programme. The median age of the patients was 55(42-65) years old with mean BMI 26.2(SD±4.7). Majority of them were of Malays ethnicity, 95(71.4%), predominantly male,75(56.4%). The primary cause for end stage kidney disease was diabetes mellitus (DM) 89(66.9%), followed by hypertension 18(13.5%). Most of the patients were on CAPD, 87(65.4%), and 76(57.1%) of them were on self-care PD. During this observational period, 29(21.8%) were trained by trainer group 1(hospital based) while a total of 104 patients underwent home based training: trainer group 2, n=44(33.1%), trainer group 3, n=44(33.1%), and trainer group 4, n=16(12.0%). The PD peritonitis rate for hospital based training was 1 episode per 55.8 patient months while home based training group was 1 episode per 25.4 patient month. The survival free to 1stPD peritonitis for home based training was 83.7% over 6 months. The exit site infection rate was 1 episode per 73.1 patient month in home based training patients. In multivariate analysis, it showed variation among trainer groups where trainer group 4 showed higher risk for peritonitis (odd ratio 8.86, p value=0.040), which was adjusted to age, gender, BMI classes and creatinine.
Conclusions
Home based PD training should be encouraged especially during Covid-19 pandemic period, but standardised training protocol should be implemented to improve the clinical outcome of our patients.
No conflict of interest