Research

NAC Research
Research is supported to address fundamental problems involving PD. Projects involving cooperation amongst sites is encouraged. Request for grants will be announced when funding is available. For further information, please contact Dr. Thomas  Golper, Chair of the Research Committee.

Research Committee Membership:
Chair: Thomas Golper
Mike Flessner
Sharon Nessim
Jeff Perl
Jimmie Pirkle
Francesca Tentori
Eric Wallace

 

Letter from Leadership of ISPD NAC NARC to participants in Peritoneal Catheter Study – August 2014

NARC – PD : An update from the Advisory Group – July 2014

Following the Nashville meeting organized by Dr. Tom Golper in the spring of 2013 a formal call for research proposals was issued by the ISPD NAC and on August 31, 2013 deadline was set for submission. Dr. Matthew Oliver and Dr. Rob Quinn were asked to co-lead a project focusing on improving PD catheter outcomes in collaboration with Dr. Tom Golper, Dr. Eric Wallace, Dr. Adriana Hung, Dr. Rachel Fissell, and Dr. Francesca Tentori.
The overarching goals of this project are to quantify the variability in PD catheter practices and outcomes in North American programs, identify key predictors of successful PD catheter outcomes, and establish a sustainable framework for ongoing quality improvement relating to PD catheter practices. This work will lay the foundation for large, multi-center, multi-national randomized controlled trials by identifying key research priorities and establishing a research network with the size and expertise to conduct them. It will also establish a sustainable model of quality improvement that facilitates benchmarking of local practice and outcomes against other programs. The vision is to make the ISPD-NAC unique as an organization that not only produces practice recommendations, but also actively participates in generating new science and providing programs with the tools required to monitor and improve their performance.
The current project has 3 main objectives:

  • To perform a survey of participating centers regarding PD catheter insertion practices to identify variation in practice and to guide development of data collection tools and a framework for quality improvement.
  • To identify important predictors of PD catheter failure with a specific focus on method of PD catheter insertion (open, laparoscopic, percutaneous), post-insertion care (flushing of catheter), and buried vs. non-buried catheters.
  • To develop a sustainable framework for ongoing quality improvement at the program level relating to PD catheter practices, determine the variability in PD catheter outcomes across programs, and identify high-performing sites.

Sites willing to participate in the North American Research Consortium were asked to declare their interest and the response was overwhelming. Thank you to the approximately 40 sites from Canada and the United States that have indicated their willingness to support the project.
A proposal was drafted and submitted to Baxter Corporation requesting start-up funds at the end of November 2013. Baxter generously agreed to provide these funds to the ISPD-NAC in support of the PD catheter project early in 2014.
Since that time, an ISPD-NAC Advisory Group was formed to oversee the project that includes Dr. Peter Blake in addition to the investigators listed above. Regular teleconferences were organized to move the project along and have made considerable progress.

The ISPD- NAC Advisory Group has:

  • Identified potential sources of funding from local, regional, and national funding agencies in Canada and the United States. The Advisory Group is currently preparing grant applications for these opportunities to secure funding to conduct the studies.
  • Drafted the survey of participating centers. This will be circulated to member sites soon.
  • Developed a study protocol and data dictionary and is currently working on finalizing the data collection platform.
  • The Advisory Group is also in discussions with dialysis providers to determine how best to collect quality improvement data at participating sites.

 

North American Research Consortium in Peritoneal Dialysis (NARC-PD)
At the Nashville NAC meeting in June of 2013 the chapter agreed to form the North American Research Consortium in Peritoneal Dialysis (NARC-PD). The first study is observational and intending to define best catheter placement and early management strategies, under the direction of Rob Quinn and Matt Oliver, with close association with Eric Wallace, Rachel Fissell, Francesco Tentori, and Jeff Perl. This project was selected for its relative ease of performance and to establish the data collection tools/methods needed for a successful transcontinental consortium.
The NAC Research Committee has the duty to first define and prioritize the future scientific studies that NARC will address, and to further enhance its success by recommending organizational and financial considerations. It answers to the NAC Executive Committee/Council.

PDOPPS Initiative
The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) is designed to advance the understanding of optimal practices for PD patients worldwide and to reduce barriers to PD use. Our hope is that the study will increase the appropriate use of PD, extend technique survival, and improve quality of life for PD patients.
Full details are provided on the home page of the ISPD website. PDOPPS is very relevant to ISPD NAC and NARC. First, PDOPPS is co-ordinated from Ann Arbor, Michigan and many NAC members are very involved. Jeff Perl, a member of our NAC Exec is taking a leadership role in PDOPPS as is Francesca Tentori from Nashville.
Already a number of Canadian sites in Toronto and In London, Ontario are up and going as PDOPPS centers. U.S. sites will soon also join. A number of research questions have been identified.

IMPENDIA published in JASN
CLICK HERE  to read the study
Congratulations to NAC members involved in the IMPENDIA randomized controlled trial, the results of which were published in the November 2013 issue of JASN. Authors include ISPD President and NAC member, Joanne Bargman, Mauro Verrelli from Winnipeg, Bruce Culleton, Ty Shockley and Ken Story from Baxter and a numerous other collaborators. The study is one of the largest randomized trials ever done in the area of PD solutions and, if we include the closely associated EDEN trial, 251 PD patients in 11 different countries were enrolled.
The primary question was whether glucose sparing PD solution regimens comprising icodextrin and amino acids could give improved metabolic outcomes compared to control solutions. The study did show significant benefits in the form of lower glycated hemoglobin and lipid levels but there was an unexpected excess of adverse outcomes related to fluid overload in those receiving the glucose sparing regimen. These findings are certainly going to stimulate discussion.