Questions About PD
We thank you for your interesting question. The RN to patient ratio varies considerably across the world, and even within countries. For example, one recently published article from Shanghai, China mentioned a ratio of 1 RN to 125 patients (1). Australia has recently published guidelines that note that 1 RN for every 20 to 25 patients is commonly accepted, while PD programs that are located in remote communities or have indigenous patients will need lower patient ratios (2). One of the few research articles on this topic by Ana Figueiredo in Brazil found that for an RN working an 8-hour day, 1 RN for every 25.8 patients would be appropriate (3).
Some ESRD networks in the United States specify what the ratio should be. For example, ESRD Network #14 (Texas) specifies that there should be one licenced PD nurse for every 20 patients (4). The National Forum of ESRD Networks (in the United States) published their guidelines in 2016 suggesting that there should be one fulltime RN for every 20 – 25 PD patients and noted that if the program included pediatric or home hemodialysis patients, that may justify a ratio of one fulltime RN for every 10 patients. Also noted in these guidelines is that the RN should have at least 12 months experience in providing care and 3 months of training in PD, before she provides PD training to a patient. For a new PD program, the recommendation from these guidelines was a minimum of 2 RNs (5). A program that is growing and expecting an influx of new patients will need to hire and train additional RNs ahead of the new patients needing to be trained.
In general, while guidelines on a specific RN to patient ratio vary, it should be noted that PD programs that are in a remote area, or have indigenous patients, or are growing rapidly, have pediatric patients or home hemodialysis patients may need a lower patient ratio than a program that does not have to deal with such complex issues.
For the actual training of a PD patient, 1 RN to 1 patient is considered ideal, although not necessarily always feasible (6). Further research is very much needed in this area.
- Fang, W, Ni, Z. and QianKey, J. Factors for a High-Quality Peritoneal Dialysis Program — The Role of the PD Team and Continuous Quality Improvement. Perit Dial Int 2014; Jun; 34(Suppl 2): S35–S42.
- Kidney Health Australia. Teaching Peritoneal Dialysis (PD). 2018. Available at: http://kidney.org.au/health-professionals/support/home-dialysis/teaching-peritoneal-dialysis-pd
- Figueiredo, A.F., de Souza Urbanetto, J., Bernardini, J., & Lameira Vieira, K. Determining nurse staffing for peritoneal dialysis care. Nephrology Nursing Journal 2016; 43(5):419-426.
- ESRD Network #14 Medical Review Board Standards of Care for ESRD Patients in the outpatient peritoneal dialysis setting. 2006. Available at: http://www.esrdnetwork.org/sites/default/files/content/pdf/OutpatientPDSetting-Final11-06.pdf
- Home Dialysis Toolkit Developed by the Forum of ESRD Networks’ Medical Advisory Council (MAC). 2016. Available at: http://midwestkidneynetwork.org/sites/default/files/home_dialysis_toolkit.pdf
- Piraino B, Bernardini J, Brown E et al. ISPD position statement on reducing the risks of peritoneal dialysis-related infections. Perit Dial Int 2011; 31:614–630.