Naidu P1, Yusuf F1, SUNDARAM M1, ABEYARATNE A1, Majoni W1
1Royal Darwin Hospital, Darwin, Australia
AIM: To assess Top End Health Service (TEHS) peritoneal dialysis service provision (2000 to 2021) by reviewing peritoneal dialysis (PD) associated infections and exit outcomes.
BACKGROUND: The Northern Territory has the highest prevalence of chronic kidney disease (CKD) in Australia overwhelming current service capacity for facility haemodialysis. Accessing facility haemodialysis also necessitates relocation to major centres. Peritoneal dialysis (PD) relieves both these burdens. This means a service emphasis on preventable PD-associated infections, as they can lead to loss of access, permanent transition to haemodialysis, and death.
METHODS: PD patient data collected from 2010 to 2021 for ANZDATA and from medical records was used. Data was compared to a 2000 – 2010 TEHS internal audit. Excluded patients: treatment started or continued in another health service or planned but not started PD.
RESULTS: 2010 – 2021
202 PD patients with 219 episodes of peritonitis and 61 line infections. 40 months average time on PD. Average of one episode of any infection per 29 months. 42 patients died on PD. 21 transplanted after an average of 7 months. 93 patients moved to haemodialysis, in 60% of cases due to infective complications. 51% of all infections were caused by gram positive organisms (33.4% gram negative, 6.7% fungal and 9% culture negative).
116 PD patients – 233 total PD-related infections (average infection rate one episode per 11 months). 24 month median technique survival. 5 were transplanted. 51.3% of all infections were caused by gram positive agents (19.3% gram negative, 5.5% mixed, 8.3% fungal and 15.4% culture negative).
CONCLUSION: TEHS PD service has improved outcomes in technique survival and transition to transplant. However, outcomes can be improved comparative to literature.
Dr Paayal Naidu is a current first year renal advanced trainee at Royal Darwin Hospital with dual train in general medicine and nephrology. She has research interests in epidemiology and preventative, proactive public health measures with particular focus on marginalized and under-privileged populations. Her time in the Northern Territory has been invaluable in demonstrating how entrenched health systems impact on Indigenous health and ways to address this.