Jha Vivekanand, Abrahams Alferso C, Al-Hwiesh Abdullah, Brown Edwina A, Cullis Brett, Dor Frank J M F, Mendu Mallika, Ponce Daniela, Divino-Filho José Carolino
George Institute for Global Health India, New Delhi, India.
School of Public Health, Imperial College, London, UK.
Clin Kidney J. 2022 May 12;15(12):2177-2185. doi: 10.1093/ckj/sfac136. eCollection 2022 Dec.
Barriers to accessing home dialysis became a matter of life and death for many patients with kidney failure during the coronavirus disease 2019 (COVID-19) pandemic. Peritoneal dialysis (PD) is the more commonly used home therapy option. This article provides a comprehensive analysis of PD catheter insertion procedures as performed around the world today, barriers impacting timely access to the procedure, the impact of COVID-19 and a roadmap of potential policy solutions. To substantiate the analysis, the article includes a survey of institutions across the world, with questions designed to get a sense of the regulatory frameworks, barriers to conducting the procedure and impacts of the pandemic on capability and outcomes. Based on our research, we found that improving patient selection processes, determining and implementing correct insertion techniques, creating multidisciplinary teams, providing appropriate training and sharing decision making among stakeholders will improve access to PD catheter insertion and facilitate greater uptake of home dialysis. Additionally, on a policy level, we recommend efforts to improve the awareness and feasibility of PD among patients and the healthcare workforce, enhance and promulgate training for clinicians-both surgical and medical-to insert PD catheters and fund personnel, pathways and physical facilities for PD catheter insertion.
在2019年冠状病毒病（COVID-19）大流行期间，获得家庭透析的障碍对许多肾衰竭患者来说成了生死攸关的问题。腹膜透析（PD）是更常用的家庭治疗选择。本文全面分析了当今世界各地进行的PD导管插入手术、影响及时进行该手术的障碍、COVID-19的影响以及潜在政策解决方案的路线图。为了证实该分析，本文包括对世界各地机构的一项调查，问题旨在了解监管框架、进行该手术的障碍以及大流行对能力和结果的影响。基于我们的研究，我们发现改善患者选择流程、确定并实施正确的插入技术、组建多学科团队、提供适当培训以及在利益相关者之间共享决策，将改善PD导管插入的可及性，并促进家庭透析的更多采用。此外，在政策层面，我们建议努力提高患者和医护人员对PD的认识和可行性，加强并推广针对外科和内科临床医生插入PD导管的培训，并为PD导管插入提供人员、途径和物理设施方面的资金支持。
