Patient education status regarding peritoneal dialysis: a questionnaire-based survey study
Authors: Ryuzaki Munekazu , Inoue Shuji , Morimoto Kohkichi , Wakabayashi Kaoru , Yoshifuji Ayumi , Komatsu Motoaki , Fujii Kentarou , Kato Ai , Honjoh Honami , Wakino Shu , Uchiyama Kiyotaka , Itoh Hiroshi 
Published: February 2025

Abstract

Background
The number of patients undergoing peritoneal dialysis (PD) in Japan has recently increased. However, Japanese guidelines for such patients’ education are not yet available. Therefore, we aimed to investigate the present status of patient education regarding PD in Japan.

Methods
We used one questionnaire to perform two rounds of surveys (2019 and 2021) at institutes that managed ten patients or more on PD at the end of each year. We evaluated the facilities’ characteristics, catheter placement, PD guidance, educational content, education management, home-care environment, care of exit site, and bathing and retraining.

Results
A total of 76 facilities (response rate: 26.8%) responded to the first survey, and 86 (response rate: 28.3%) to the second. The incidence of peritonitis in the valid responding institutes was 0.21 per patient-year in 2019 and 0.19 per patient-year in 2021, similar to the incidence of 0.20 per patient-year in 2022 reported by the Japanese Society for Dialysis Therapy Renal Data Registry. This indicates that the valid responding institutes may have been representative of the typical Japanese clinical level in terms of PD. In terms of catheter placement, exit-site positions were preoperatively marked by nurse in 41% of facilities in 2019 and in 37% in 2021. In terms of PD guidance, regarding the timing of the education’s initiation, the periods before PD catheter placement or during catheter embedding were more common than 1–6 days after placement in both years. In terms of the duration, 30-min to 1-h education sessions were most common, and the majority of facilities provided guidance for more than 7 days in both years. These results were different from the schedules recommended by the International Society for Peritoneal Dialysis (3 h per session for more than 5 days, initiated 10 days after the operation). Regarding educational content, most facilities provided education on PD procedures and bathing; however, in some facilities, the content did not include dietary guidance, the importance of residual kidney function, medications, laboratory data, troubleshooting, medical security, or social resources. In both years, approximately 70% of the instructional items comprised the PD procedure, exit-site care, bathing, and infection prevention. Regarding education management, the patients’ levels of understanding were evaluated via manual or oral tests in most of the facilities. Regarding the method of demonstration, the entire procedure was explained during the demonstration in almost all institutes. Nurses in > 50% of facilities visited the patients’ homes either when PD was introduced or as needed. The majority of facilities did not use cognitive-function tests when PD was introduced to older adults. Regarding exit-site care and bathing, no consensus existed. Almost half of facilities performed regular, scheduled retraining.

Conclusions
In this study, patients’ PD-related educational situations differed from those recommended by the International Society for Peritoneal Dialysis, and no consensus for exit-site care or bathing existed. To improve the clinical level of PD practice in Japan, original Japanese guidelines for patients’ PD education are required, for which our results may serve as the foundation.