2. Keys to Achieving Standard of PD Care
• Ensuring appropriate patient selection for PD
• Ensuring optimal patient training and continuous
support
• Monitoring PD performance: KPI
• Establishing a continuous quality improvement
(CQI) approach to PD practice: CPG.
3. What is the Most Important PD-KPI ?
a) Patient mortality rate
b) Patient survival rate
c) Technique survival rate
d) Exit-site & Peritonitis rate
e) PD adequacy & volume control
f) Quality of life of patients
g) PD nurse to patient ratio
5. Aims of KPI
“If you can’t define it, you can’t measure it;
if you don’t measure it, you won’t improve it”
6. KPI Based on
• Strategic themes & Critical success factors
• Good KIP ต้องประกอบด้วย “SMART”:
S • Specific: จำเพำะ ชัดเจน เข้ำใจง่ำย
M • Measurable: สำมำรถวัดผลกำรปฏิบัติได้
A • Attainable: สำมำรถบรรลุหรือสำเร็จได้
R • Realistic: สอดคล้องกับควำมเป็นจริง
T • Timely: วัดได้ตำมช่วงเวลำที่กำหนด
8. CPD-KPI: ACN & TSN (1)
KPI type KPI: both Target
Structure Nephrologist No P/P 1:50, 1:100
Structure PD nurse No N/P 1:30, 1:50
ACN = ISPD Asian Chapter Newsletter, TSN = Thai Society of Nephrology
9. CPD-KPI: ACN & TSN (2)
KPI type KPI: both Target
Process % of pt with adequacy measured in
last 6 mo
> 80, 80%
Process % of pt visit at home in last 6 mo >80, 80%
Process Pt receiving prophylactic ATB prior
TK insertion
> 95, 90%
Process % of pt with break in period > 2 wk > 80, 80%
ACN = ISPD Asian Chapter Newsletter, TSN = Thai Society of Nephrology
10. CPD-KPI: ACN & TSN (3)
KPI type KPI: ACN only Target
Process Pre-dialysis patient education > 65%
Process % of pt with nasal staph carriage
treated with mupirocin
>80%
ACN = ISPD Asian Chapter Newsletter, TSN = Thai Society of Nephrology
11. CPD-KPI: ACN & TSN (4)
KPI type KPI: both Target
Clinical
Clinical
% of pt with anemia Rx protocol
target
% of pt with serum PO4 within
KDIGO target
> 70 at 10-12
g/dl, 70%
>70, 70%
Clinical % of pt with total weekly Kt/V > 90%, 70%
Clinical Peritonitis rate (1 episode/pt-mo) >1:30, 1:24
ACN = ISPD Asian Chapter Newsletter, TSN = Thai Society of Nephrology
12. CPD-KPI: ACN & TSN (5)
KPI type KPI: both Target
Clinical
Clinical
Clinical
Exit-site infection rate
% of C/S negative
1 yr pt survival at %
> 1:50, 1:48
< 20, 20%
> 90, 80%
Clinical 1 yr technique survival (Non-
Death censor)
> 85, 85%
Clinical 3 yr technique survival >75, 65%
ACN = ISPD Asian Chapter Newsletter, TSN = Thai Society of Nephrology
13. CPD-KPI: ACN & TSN (6)
KPI type KPI: both Target
Clinical
Clinical
Clinical
Bowel perforation
Significant hemorrhage
ESI < 2 wk of TK insertion
< 1, 1%
< 1, 1%
< 5, 5%
Clinical Peritonitis < 2 wk of TK insertion < 5, 5%
Clinical Functional problem requiring
manipulation or replacement or
leading to technique failure
< 20, 20%
ACN = ISPD Asian Chapter Newsletter, TSN = Thai Society of Nephrology
14. CPD-KPI: ACN & TSN (7)
KPI type KPI: ACN only Target
Clinical
Clinical
Clinical
% of pat with BPs 105-140 mmHg
Time on therapy (mo)
Drop out rate
> 80%
> 48
< 30%
Clinical 1 yr catheter patency (death and
shift mode censoring)
< 5%
ACN = ISPD Asian Chapter Newsletter, TSN = Thai Society of Nephrology
15. CPD-KPI: ACN & TSN (8)
KPI type KPI: TSN only Target
Clinical
Clinical
Clinical
% of pt with serum Ca 8.4-9.5 mg/dl
% of pt with PTH 150-500 pg/ml
% of pt with albumin > 3.8 g/dL
> 70%
> 70%
> 70%
Clinical 3 yr pt survival (death??, KT &
renal recovery censor) %
>70%
ACN = ISPD Asian Chapter Newsletter, TSN = Thai Society of Nephrology
18. Peritonitis may be evaluated by
1. Rates
a) เวลาที่มีความเสี่ยงจากการทา PD / จานวนครั้งของการ
ติดเชื้อ (pt-months/episode)
b) จานวนครั้งของการติดเชื้อ / เวลาที่มีความเสี่ยงจากการ
ทา PD (episodes/pt-year)
2. % of pt who are infection-free per period of time
3. Median infection rate for the program
(Beth Piraino, Professor of Med at U of Pittsburgh)
21. การคานวณอัตราการติดเชื้อ (3)
Center 1 Center 2
เวลาที่มีความเสี่ยงจากการทา PD
/ จานวนครั้งของการติดเชื้อ
11.3
(pt-mo/episode)
11.3
จานวนครั้งของการติดเชื้อ / เวลาที่
มีความเสี่ยงจากการทา PD
1.06
(episode/pt-yr)
1.06
% of pt who are infection-
free per period of time
28.6% 57.1%
Median infection rate for the
program
1.2
(episode/pt-yr)
0
23. Calculation of Crude Mortality Rate
Crude MR
= All deaths in a calendar year × 10n
Population at mid year
Crude MR (2540-2543)
= 2 × 100 / 6 = 33% ต่อ 4 ปี
28. การวัดการเกิดเหตุการณ์ (Event)
• Failure (1): เกิดเหตุการณ์: ตาย, technique failure etc
• Censor (0): ยังไม่เกิดเหตุการณ์ เมื่อ
o เมื่อสิ้นสุดระยะเวลาที่ศึกษา
o Withdraw: KT
o Lost to follow-up
o ตายเนื่องจากสาเหตุอื่นก่อนเหตุการณ์เกิด
33. Time On Therapy (TOT)
• the number of months it takes 50% of patients
to leave the therapy.
• a measurement of median time in months on
PD for pt initiated therapy.
• The maximum TOT is 60 months, even if you
have patients who have been on PD longer.
34. TOT vs DOR: Formula
TOT (months)
= sum of DO patients (date for DO – date for
initiating PD) / (30 x DO patient no (n))
DOR (%)
= current yr DO pt no (n) / (last yr survival pt no
(n) + current yr net gain pt no (n) / 2)
35. DOR: calculation
DO rate 09 = No DO (exclude KT)
Actual 08 + (new 09 – loss 09)/2
= 7 / (34 + (30-10)/2) = 15.9%
12 Month data 2008 2009
#Pt Loss (excluding KT) 5 7
# Pt beginning of yr 20 34
#New PT 20 30
#Pt loss (total) 6 10
Dropout rate 15.9%
44. ISPD 2015: Management of Various
CV Complications
3.2.6 We suggest peritoneal dialysis patients with heart
failure and anemia receive treatment for anemia and
have target hemoglobin no different from peritoneal
dialysis patients without heart failure. (2D)
(Peritoneal Dialysis International, 2015: 35, 388–396)
45. Strength of Recommendation
Level 1
“we recommend”
Corresponds to
“strong” in grade
Level 2
“we suggest”
Corresponds to
“weak” or dis-
cretionary in grade
47. ISPD Cardiovascular and Metabolic Guidelines
in Adult PD Patients-II:
• There are altogether 26 guidelines statements
o 5 are level 1 or “strong” recommendations
o 18 are level 2 or “weak” recommendations
o 3 are ungraded
• Each guideline statement is provided with a brief
rationale paragraph and key references.
(Perit Dial Int 2015; 35: 388–96)
48. ISPD 2015: Management of Various
CV Complications (1)
3.2.6 We suggest peritoneal dialysis patients with heart
failure and anemia receive treatment for anemia and
have target hemoglobin no different from peritoneal
dialysis patients without heart failure. (2D)
(Peritoneal Dialysis International, 2015: 35, 388–396)
49. ISPD 2015: Management of Various
CV Complications (2)
RATIONALE: Current available evidence does not support
correction of anemia as a therapeutic strategy for
regressing LVH and dilatation or preventing heart failure in
PD patients. No RCT has examined whether treatment of
anemia may improve hard outcomes of PD patients with
heart failure. (NO REFERENT)
(Peritoneal Dialysis International, 2015: 35, 388–396)
