Table 1.

Barriers to urgent-start peritoneal dialysis

BarriersInterventions
Provider-related factors
 Lack of knowledge and experience among cliniciansEducation of nephrologists and surgical trainees/interventionalists about PD catheter insertion techniques
 Misconceptions or biases about PDVisits to centers of excellence for fellows and nephrologists for hands-on experience
 Timely PD catheter insertionIdentify dedicated surgeons, interventional radiologists, or nephrologists for PD catheter insertion for urgent starts
Education of surgical trainees/interventionalists about PD catheter–insertion techniques
Courses for surgeons and interventionalists to provide hands-on experience about catheter-implantation procedures
Infrastructure-related factors
 In hospital
  Delay in PD catheter insertionHaving structured protocol for urgent-start PD
  Lack of effective communication between hospital and outpatient PD center staffIdentify dedicated personnel to streamline the process of education, and coordination of care between hospital and outpatient PD center
Outpatient PD unit
  Unable to accommodate urgent initiation due to lack of individual rooms for training or trained staffIdentify dedicated personnel to communicate with in-hospital team and for home visit
Availability of adequate clinic rooms in the PD unit
Ensuring adequate PD nurses and resources
Patient-related factors
 Lack of patient awareness about home modalitiesWell-designed in-hospital patient education program
 Patient refusalAssess the cause of refusal
 Physical
  Reduced physical strength to lift PD bagsAssistance by home care partner
  Reduced dexterity to make connectionsAssisted PD if available
  Reduced vision/hearing
 Cognitive impairment such as dementia or learning disabilities
  • PD, peritoneal dialysis.