Expanding home dialysis across the world - BC Renal Agency

Dr. Suneet Singh

Objectives• Describe the initiative to promote therecognition and treatment of kidney diseasein the developing world• ISN Sister renal cities Fellowships Education material• Describe our experience recently with afellow from India Sponsored by the B.C. Provincial Renal Agency

Goals of the one year fellowship• Expertise in the selection, education andmanagement of patients choosing PD• Expertise in the insertion/removal andmanagement of PD catheters• Expertise in the fundamentals of patient careon PD including adequacy, peritonitis,ultrafiltration failure, and transition to HD• Research/ QI project

Longer term goal• On return to area of work: Promote PD as a longterm option for RRT Provide local education to patients and careproviders Resource for others to initiate /contribute to PD Continued relationship with B.C. for continuingeducation and sharing of strategies and educationmaterial Site visit (waiting...)

How did we get started?• University Health Network—connection withIndia for some time Funding made available by PRA A colleague from Toronto made arecommendation Phone interview process Whole bunch of paperwork...

Dr. Manish Jain

Dr. Manish Jain

Clinical work• PD catheter insertions/removals• PD clinics• New patient assessment• Worked with training nurses—reviewededucation material, attended both CAPD andCCPD training sessions• Weekly bloodwork, patient care rounds• Management of diabetes in PD• Reviewed established protocols

Scholarly work• Literature review on: Peritonitis and exit site managment Anemia management Ultrafiltration failure Membrane physiology Solutions

Research• Retrospective review of bedside PD catheterinsertion at SPH and VGH over 5 years Chart review Promis database Success, complications and outcomes of bedsidePD tubes Presented at the World Congress of Nephrology,Vancouver 2011 Paper in progress

His perspective• Dedicated PD unit‐Doctors as well as staff. Best thing for patient aswell the unit handling them. Here we ve to do everything...so itdepends lot on Doctor how they explian to patient Re what modalityof therapy to choose.• Structured program.• PD Tours‐CKD 4 patients get well versed with the RRT modalities sothey get mentally prepared for the therapy they want to opt.• PD Catheter insertions‐though back here it is still done by theSurgeon.• APD ‐ since we ve small no of patients on PD so exposure to APD isvery less.• Dedicated PD clinics.• In our hospital we explain them all the modalitis to patient thanultimate choice is theirs...I explain them PD is not inferior to HD inanyways which is a common belief among them.

Con’t...• I motivate working people or far living ones who have to travellong for HD to go for PD.• Patients who do not want to do it themselves we train theattendants(though we train one attendant in any case) as wellexplain them about cycler to affordable group.• We try to make AV fistula in all the cases.• We have around 25 patients on PD at present...biggest hurdlehere is Doctor's bias as well patients also think its better tocome to hospital...dont want to do it themselves..• I would definitely recommend it to others...my fellowshiptraining exclusively on PD was really fruitful as PD is the mostneglected thing of our training...moreover working with youand Dr.Taylor was very good expierence...at a single go I hadan opportunity to work with both of you..different protocols

Challenges for us asteachers• Understanding the medical system that hereturns to• Infrastructure limitations• Cultural boundaries and our assumptions• Getting the paper completed

Challenges for PD in India• Not very different from here.. Patient bias Physician and allied health bias Misunderstanding of the data and outcomes Lack of education for physicians and nurses Promotion based on $ rather than well being Inappropriate infrastructure• Improving