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The dialysis census published by the Brazilian Society of Nephrology in 2022 estimated 153,831 patients on dialysis in Brazil, being 95.3% of them on hemodialysis (HD) and 4.4% on peritoneal dialysis (PD)¹. Despite the greater comfort and practicality in relation to HD, the prevalence of PD remains very low, and among the causes it is able to cite the inappropriate education of patients about home dialysis, shortage of trained medical and nursing staff, lack of infrastructure for urgent start PD support, infections as a cause of therapy failure, among other factors². It is essential to know the quality of home peritoneal dialysis treatment, so that professionals can be encouraged and have the means for revitalizing the program by reducing the complications of the method, and thus, be a priority indication in dialysis treatment. The study's objective is to evaluate the PD quality indicators of a dialysis clinic in Florianópolis and to profile the episodes and outcomes of peritoneal infections.
A retrospective descriptive study was carried out on the medical records of patients in the PD program of a dialysis clinic in the year 2022 in Florianópolis, Santa Catarina, Brazil. The following quality indicators in PD were evaluated: rate of penetration into therapy, choice of therapy by newly diagnosed patients (Take on Rate-TOR), time in therapy (Time on Therapy-TOT), exit from therapy (drop out) and its reasons, in addition to the rates of peritonitis with the respective causative agents.
Out of the 289 patients on dialysis, 113 were on PD at the end of the period, with a therapy penetration rate of 39% (average in Brazil is 6.8%). The average time on PD was 41.2 months (average in Brazil is 27 months), with the method being chosen 26% of the time (Brazil 0.7-3.9%). A drop out rate of 34% was found (global average is 16-35%), the main reasons being deaths (22%), change of method (12%) and kidney transplantation (7%). Regarding peritonitis, 31 episodes were recorded in 2022, with a rate of 0.27% patients per year. Considering the target of up to 0.5%, it is clear that patient care in the method is being taken into consideration. Of these peritonitis, 21.87% were caused by coagulase-negative staphylococci, 15.62% by Escherichia coli, 9.37% were culture negative, 6.25% by Pseudomonas aeruginosa and the remainder distributed among other bacteria. All bacteria found were sensitive to third-generation cephalosporins. No deaths related to peritonitis were recorded, but 6 cases (18.75%) had therapy failure due to the infection.
The reason the sample presented good quality indicators may have been due to the selection of a clinic already considered a reference for the method in Florianópolis. The existence of strict control and monitoring that lead to early interventions determines good clinical results. Understanding and addressing the various issues that hinder the PD treatment can help increase the prevalence of PD in Brazil and around the world.