The North American Chapter has made significant investments to catalyze an increase in hypothesis-driven research in the field of peritoneal dialysis. There are three initiatives funded and/or supported by the North American Chapter:
North American Research Consortium (NARC-PD)
Lead Investigators: Matthew Oliver (Sunybrook Hospital, Toronto, ON), Rob Quinn (University of Calgary, Calgary, AB)
Update (April 2016)
There is strong interest across dialysis programs in North America to participate in a registry for peritoneal dialysis catheters, as evidenced by the completion of the survey and sites expressing interest in joining the project. Most programs participate in some form of local quality improvement, but there is wide variability in practices and a lack of standardized definitions. Further, best practices are not based on actual program performance measured by an independent system.
Experts in the field have identified key variables that may determine outcomes but there must be strong engagement of the operators (surgeons, radiologists, nephrologists, and advance practiced nurses) who insert peritoneal dialysis catheters in order to capture this information. Outcomes should be defined by using objective measures and diagnostic criteria in order to facilitate data alignment (e.g., P-DOPPS) and clear definitions. Important outcomes to track include inflow/outflow problems, infections, bleeding, leaks, drain pain and extruded cuffs or other damage to catheters. We also have to be sensitive to privacy issues using data anonymization and controlling access to the data contained in the registry.
We have built a demonstration version of the registry, which is currently undergoing testing. Research agreements are being established to transfer data to the Sunnybrook Research Institute. We have analyzed pilot data which demonstrates a significant portion of patients had at least one complication related to their catheter. One third of patients have had to stop peritoneal dialysis at least temporarily as a result of these complications. Data from other programs is now required to determine how widespread this problem is and identify potential ways of addressing it.
Wallace EL, Fissell RB, Golper TA, Blake PG, Lewin AM, Oliver MJ, Quinn RR. Catheter insertion and perioperative practices within the ISPD North American Research Consortium. Perit Dial Int 2015 (epub ahead of print)
Peritoneal Dialysis Outcomes and Practice Patterns (PDOPPS)
Lead Investigators: Jeffrey Perl (St. Michael’s Hospital, Toronto, ON), Bruce Robinson (Arbor Research Institute, Ann Arbor, MI)
Update (April 2016)
The international Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) project is the largest international prospective cohort study of practice of peritoneal dialysis and outcomes with the therapy, developed in close collaboration between the International Society for Peritoneal Dialysis (ISPD) and Arbor Research Collaborative for Health (Ann Arbor, Michigan, USA). Launched in 2012, the PDOPPS is a groundbreaking research initiative for understanding and advancing peritoneal dialysis therapy and determining optimal practices for peritoneal dialysis patients worldwide. Continuing the DOPPS mission of improving outcomes and care for dialysis patients, the PDOPPS conducts clinical research to promote the appropriate use of peritoneal dialysis, extend technique survival, and improve quality of life for patients undergoing peritoneal dialysis.
The pilot study launched in October 2013, with longitudinal data collection starting in Canada and the United States in January 2014. The PDOPPS quickly expanded to Japan by late 2014, and Australia, New Zealand, and the United Kingdom joined the study in 2015, with plans to initiate in Thailand in the first half of 2016. Across the six participating countries where data collection is underway, the study has already enrolled over 4000 patients across 180 participating study sites. In the USA, PDOPPS will also soon be expanding to include representation from all large dialysis organizations including DaVita Healthcare which has recently joined the study, with a target recruitment of 100 facilities in the USA. In Canada, the study is entering its third year with representation from 20 facilities and the recruitment of 755 patients to date. For more information please visit us at: http://www.dopps.org/PDOPPS/AboutthePDOPPS.aspx
Perl J, Davies SJ, Lambie M, Pisoni RL, McCollough K, Johnson DW, Sloand JA, Prichard S, Kawanishi H, Tentori F, Robinson BM. The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS): Unifying Efforts to Inform Practice and Improve Global Outcomes in Peritoneal Dialysis. Perit Dial Int 2015 (epub)
Geriatric Assessment for Patients Starting Peritoneal Dialysis
Lead Investigators: Vanita Jassal (University Health Network, Toronto, ON), Matthew Oliver (Sunybrook Hospital, Toronto, ON)
Update (April 2016)
Peritoneal dialysis is being promoted to increase the use of home dialysis, reduce reliance on in-center hemodialysis, and decrease the cost for the treatment of end-stage renal disease. However as the population ages, more individuals have barriers to self-care and therefore need assistance to receive peritoneal dialysis in their homes.
This project is designed to better understand the practical impact of patient-related factors such as frailty, physical function and cognitive impairment, on the ability to manage individual self-care tasks required for peritoneal dialysis care.
The specific aims of this proposal are: (1) to determine the feasibility of conducting a comprehensive geriatric assessment as part of assessment for patients for peritoneal dialysis; (2) to determine the type and quantity of assistance required by older patients undergoing peritoneal dialysis; and (3) to assess the degree and direction of changes in the level of independence with peritoneal dialysis related tasks over time.
To date, the project has recruited 128 patients, aged ≥ 65 years at the time of dialysis initiation, across three large peritoneal dialysis centers in Ontario. The comprehensive geriatric assessment was feasible in 96% of patients at baseline. Approximately 40% of patients have completed the 6-month follow up study period, while the majority continue to be followed. Of those who have completed the study, patients have an average of 4 follow up assessments over the 6 month period. Follow up assessments include a detailed evaluation of which tasks related to peritoneal dialysis are being done by the patient, which are delegated to a caregiver or family member and which require formal assistance from a paid care provider. Preliminary data suggest a high, but stable burden of functional dependence amongst those starting peritoneal dialysis. Assistance is often given at the onset of the treatment, however several patients also report that they perceive being able to independently perform the task were they required to.
NAC Research – Archives