Authors (including presenting author) :
CHAN WCV (1), YUEN SK (2), LEUNG WYF (1), CHAN PYK (1)
Affiliation :
(1) Department of Occupational Therapy, Caritas Medical Centre (2) Department of Medicine & Geriatrics, Caritas Medical Centre
Introduction :
End-stage kidney disease (ESKD) often necessitates peritoneal dialysis (PD) as a life-sustaining treatment. However, patients with limitations in hand function, vision, and cognition may exhibit borderline performance in PD, increasing the risk of peritonitis and dependence on caregivers or institutional care. There is a notable service gap to provide timely assessments and rehabilitation to optimize their functional capability.
Objectives :
To bridge the gap, a pilot program emphasizing comprehensive assessment and individualized intervention was introduced in Caritas Medical Centre, to enhance PD techniques and outcomes.
Methodology :
The program utilized structured assessments to identify core competencies that affect future PD performance and increase peritonitis risk. This enabled renal doctors and nurses to grasp a deep understanding of patients' capabilities and make informed decisions on kidney replacement therapy. Problems identified were addressed through personalized interventions designed to enhance PD technique. It included rehabilitation training targeting at peritonitis risk factors and prescription of PD assistive devices. On-site training allowed patients to generalize learnt skills into real-life home environment.
Result & Outcome :
From April 2023 to March 2024, eighty-two patients completed the pre-dialysis assessment and twenty-five of them had borderline self-PD performance. Of these, twenty patients underwent targeted interventions and achieved significant improvements in both disinfection (Z = -2.994, p = .003) and dialysis procedures (Z = -2.959, p = .003). Ninety percent of them successfully converted their treatment plan from helper-assisted PD to self-managed PD. By December 2024, there was a marked difference in crude peritonitis rates between trained and untrained patients. Within first year of home PD, peritonitis occurred in 35% of trained patients versus 100% among who declined the interventions, despite comparable baseline demographics. This marked reduction in peritonitis and PD technique failure was attributable to our pre-training interventions. An extrapolating cost-saving analyses suggested an annual savings of over $1 million associated with peritonitis-related hospitalizations and treatment. Moreover, four patients failing the initial assessment opted out of PD, allowing them to make informed decisions, avoid unnecessary operations while further reduce medical-related costs. Our proof-of-concept program demonstrated that pre-PD assessments and interventions by Occupational Therapists significantly improved patients’ PD performance, reduced peritonitis risks and was cost-saving to Hospital Authority. Service development should be considered to support routine pre-PD referral to Occupational Therapists.
