Multi-center, pragmatic, cluster-randomized, controlled trial of standardized peritoneal dialysis (PD) training versus usual care on PD-related infections (the TEACH-PD trial): trial protocol
Authors: Chow Josephine S. F. , Boudville Neil , Cho Yeoungjee , Palmer Suetonia , Pascoe Elaine M. , Hawley Carmel M. , Reidlinger Donna M. , Hickey Laura E. , Stastny Ruth , Valks Andrea , Vergara Liza , Movva Ramya , Kiriwandeniya Charani , Candler Hayley , Mihala Gabor , Buisman Bernadette , Equinox Keri-Lu , Figueiredo Ana E. , Fuge Trudi , Howard Kirsten , Howell Martin , Jaure Allison , Jose Matthew D. , Lee Anna , Miguel Susana S. , Moodie Jo-anne , Nguyen Thu T. , Pinlac Geraldine , Reynolds Annie , Saweirs Walaa W. M. , Steiner-Lim Genevieve Z. , TeWhare Bronwen , Tomlins Melinda , Upjohn Megan , Voss David , Walker Rachael C. , Wilson Joanne , Johnson David W. 
Published: November 2023

Abstract
Background
Peritoneal dialysis (PD)-related infections, such as peritonitis, exit site, and tunnel infections, substantially impair the sustainability of PD. Accordingly, PD-related infection is the top-priority research outcome for patients and caregivers. While PD nurse trainers teach patients to perform their own PD, PD training curricula are not standardized or informed by an evidentiary base and may offer a potential approach to prevent PD infections. The Targeted Education ApproaCH to improve Peritoneal Dialysis outcomes (TEACH-PD) trial evaluates whether a standardized training curriculum for PD nurse trainers and incident PD patients based on the International Society for Peritoneal Dialysis (ISPD) guidelines reduces PD-related infections compared to usual training practices.

Methods
The TEACH-PD trial is a registry-based, pragmatic, open-label, multi-center, binational, cluster-randomized controlled trial. TEACH-PD will recruit adults aged 18 years or older who have not previously undergone PD training at 42 PD treatment units (clusters) in Australia and New Zealand (ANZ) between July 2019 and June 2023. Clusters will be randomized 1:1 to standardized TEACH-PD training curriculum or usual training practice. The primary trial outcome is the time to the first occurrence of any PD-related infection (exit site infection, tunnel infection, or peritonitis). The secondary trial outcomes are the individual components of the primary outcome, infection-associated catheter removal, transfer to hemodialysis (greater than 30 days and 180 days), quality of life, hospitalization, all-cause death, a composite of transfer to hemodialysis or all-cause death, and cost-effectiveness. Participants are followed for a minimum of 12 months with a targeted average follow-up period of 2 years. Participant and outcome data are collected from the ANZ Dialysis and Transplant Registry (ANZDATA) and the New Zealand Peritoneal Dialysis (NZPD) Registry. This protocol follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines.

Discussion
TEACH-PD is a registry-based, cluster-randomized pragmatic trial that aims to provide high-certainty evidence about whether an ISPD guideline-informed standardized PD training curriculum for PD nurse trainers and adult patients prevents PD-related infections.

Trial registration
ClinicalTrials.gov NCT03816111. Registered on 24 January 2019.