Perceptive barriers to peritoneal dialysis implementation: an opinion poll among the French-speaking Belgian nephrologists

Abstract

Although peritoneal dialysis (PD) is recognized as an effective renal replacement therapy (RRT) alternative to haemodialysis (HD), its prevalence is around 15% in most of the industrialized countries. In the French-speaking part of Belgium, PD is clearly underused with a prevalence of 8.7% in 2009. The main objectives of this work were to evaluate the nephrologists' perceived obstacles to PD implementation and reflect on possible actions towards PD development. A computer-based 33-item questionnaire was sent by e-mail to all nephrologists affiliated to the French-speaking association. Among 120 adult nephrologists targeted by this inquiry, 97 completed the online questionnaire (response rate 80.8%). Among them, 29% had little experience with PD (treating less than five patients) and 39% reported no specific training with this modality of RRT. However, 88% of responders claimed PD prevalence should be around 20-25%. Half of the responders would choose PD as a first RRT option if they required RRT for themselves. The three main reasons given to the low prevalence of PD were an easy access to HD, patient refusal and lack of nephrologist motivation. Almost all the nephrologists insisted on the need for a dedicated nursing team delivering an effective educational programme and PD management and care. They believe that PD could and should be implemented in Belgium. Enhanced nephrologist motivation and training in PD were identified as predominant factors to be upgraded, as well as patient education programmes.

Keywords: barriers; educational nephrology; peritoneal dialysis; pre-dialysis care; renal replacement therapy.

Fig. 1.

Prevalent ESKD patients in the French-speaking part of Belgium. Patients are distributed according to the different RRT modalities from 2000 to 2010: in-centre HD is the predominant RRT modality when compared with self-care HD in satellite units (also called low-care HD) and PD. The proportion of renal grafts has significantly increased during the last decade.

Fig. 2.

Nephrologists' first choice of RRT if they suffered from ESKD themselves (living donor excluded). The top selected modality is clearly automated PD (APD) whatever the nephrologists' own experience in PD care (< or >20 years, as represented by dark and light blue histograms, respectively). The second most chosen modality is home HD, followed by self-care HD in a satellite unit or continuous ambulatory PD (CAPD), depending on the duration of the responders' own experience in PD care. In-centre HD was the least selected option.