Over 20 years ago, the National Kidney Foundation (NKF) created the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines to improve the diagnosis and treatment of kidney disease. These guidelines include information on best practices for both hemodialysis (HD) and peritoneal dialysis (PD). The last time the KDOQI guidelines were updated for peritoneal dialysis was in 2006. 

As such, in 2020, the International Society for Peritoneal Dialysis (ISPD) provided new recommendations to the NKF for the KDOQI guidelines to support a more holistic and patient-centered approach for PD patients.* Learn more about these changes and why some people are concerned about them.

What is peritoneal dialysis?

While hemodialysis works by filtering blood, PD uses a soft plastic tube (catheter) placed in the abdomen where a sterile cleansing fluid is inserted to remove toxins. PD is a more flexible option and can be done at home or while traveling. For many, the perks of being able to remain independent are important to maintain their quality of life. 

What changes were made in 2020 to the KDOQI guidelines?

The new KDOQI guidelines support ISPD’s plan to support a more patient-centered approach, which includes more education in order to empower patients and help them learn how to advocate for themselves.

“KDOQI overwhelmingly endorses the ISPD new direction that physicians should avoid a ‘cookie-cutter’ approach to and assessment of peritoneal dialysis use in their patients,” said Isaac Teitelbaum, MD, lead author and KDOQI workgroup co-chair. “The best possible care may differ from patient to patient and is dependent on the experiences, wishes, and health status of each patient.” 

The NKF hopes to achieve these patient-focused methods by developing patient-reported outcome measures for people on PD. Initiating these changes could also increase research funding for PD, as well.

What concerns are there about these changes?

With new recommendations on how PD is approached, some are concerned that healthcare providers (HCPs) may not be ready to make changes. 

People’s main worries include:

• HCPs being uncomfortable with change
• Lack of training for HCPs required to engage with patients in a new way
• Patients with limited health literacy or that are cognitively impaired
• Structural issues regarding the healthcare system

“However, the challenges are not insurmountable and should not deter a shift in practices and the culture,” said Dr. Teitelbaum.

More information on the NKF KDOQI clinical practice guidelines and the respective updates to them for PD can be found on the NKF and American Journal of Kidney Diseases (AJKD) websites.

*National Kidney Foundation. (2020, Dec. 16). Peritoneal Dialysis is not a One-Size-Fits-All Treatment, New Commentary Says [Press release]. https://www.kidney.org/news/peritoneal-dialysis-not-one-size-fits-all-treatment-new-commentary-says