Introduction:
Continuous Ambulatory Peritoneal Dialysis (CAPD) offers various advantages over hemodialysis, especially in low-resource settings like Nepal. However, its adoption remains low with only 1 in 25 patients on dialysis adopting CAPD. This study aimed to investigate what were the factors that influenced the choices of the patients currently on CAPD and the attitude and practice of currently practicing nephrologists in Nepal.
Methods:
A nationwide survey was conducted among CAPD patients and nephrologists in Nepal. The patients were interviewed by clinical specialists on peritoneal dialysis and all the nephrologists practicing in Nepal were given anonymous online questionnaires to fill.
Patient data included demographics, medical history, reasons for choosing CAPD, catheter placement, and complications. Nephrologists were surveyed about training, current practice, and reasons for not recommending CAPD as the initial choice of dialysis.
Results:
One hundred and two patients among 175 patients consented and participated in the study. They were aged between 9-94 years with average age of 51 +/- 2.1 years. Among them, 36.27% were female and 63.73% were male. Their chronic kidney disease history ranged from 1-23 years. A little more than half (54.9%) of the patients had previously undergone hemodialysis, while 17.65% had a history of failed kidney transplantation.
The most common reasons for choosing CAPD were nephrologist recommendation (44.12%), switching from hemodialysis due to complications (20.59%), and vascular access failure for hemodialysis (17.65%).
While two-thirds of nephrologists had received catheter placement training, only 33% were currently performing the procedure. This led to a significant number of patients (67%) having their catheters placed by non-nephrologists.
Nephrologists expressed various reasons for not recommending CAPD as the first choice of dialysis, including lack of PD programs or trained staff at their centers (94.12%), unpredictable PD fluid supply (76.47%), patient preference for hemodialysis (70.59%), and limited experience with CAPD (58.82%). Notably, none of the nephrologists believed that hemodialysis was superior to CAPD.
Conclusions:
This study provides valuable insights into the factors influencing CAPD adoption in Nepal. The findings highlight the crucial role of nephrologists in recommending PD and the diverse reasons why patients choose this therapy. To increase CAPD uptake, efforts must focus on enhancing nephrologist training, improving PD fluid supply, addressing patient concerns, and promoting awareness of CAPD benefits. Further research is needed to evaluate long-term outcomes and experiences of CAPD patients in this setting.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.