Title

Eligibility and patient barriers to peritoneal dialysis in patients with advanced chronic kidney disease

Date of Award

2019

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Ahmed Sokwala

Second Supervisor/Advisor

Dr. Jasmit Shah

Third Supervisor/Advisor

Dr. Ahmed Twahir

Department

Internal Medicine (East Africa)

Abstract

Introduction: The burden of chronic kidney disease is on the rise in Kenya and is a significant cause of morbidity and mortality. While definitive treatment is renal transplantation, many patients require renal replacement therapy in the form of hemodialysis or peritoneal dialysis. The predominant modality utilized in Kenya is currently hemodialysis despite peritoneal dialysis having similar survival outcomes with the potential benefit of cost-effectiveness. There is need therefore to explore why peritoneal dialysis remains underutilized and whether patient factors may be contributory to barriers that limit the uptake of peritoneal dialysis.

Purpose: The main objective of this study is to determine eligibility for peritoneal dialysis of patients considered potential candidates for the modality. In addition, barriers to the same will be determined. Further, the impact of support (family support or paid assistance) on PD eligibility will be determined.

Methods: This was a descriptive cross-sectional study where patients who are potentially PD candidates were consecutively recruited. A multidisciplinary team assessed these patients for PD eligibility and this was done using a standardized tool. Contraindications and barriers to the modality were recorded as was the presence or absence of support for the provision of self-care PD. Other demographic and clinical data were also recorded using a standardized questionnaire. The impact of support on peritoneal dialysis eligibility was also determined.

Results/Conclusion: In this study on eligibility of patients with advanced CKD for self-care PD we found 68.9% of the patients eligible. Surgery-related abdominal scarring was the most common contraindication. Barriers to self-care PD were identified in 45.9% and physical barriers were more common than cognitive barriers. Presence of support was associated with a significant increase in PD eligibility (P<0.001%).

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