Reduction of Peritoneal Dialysis-Related Infections and Improving Technique Survival by Home Visits: An Observational Study in a Southern County in Taiwan

BACKGROUND: Peritoneal dialysis (PD) offers reduced costs compared with hemodialysis, and is a good option for self care of patients living in rural areas. Currently, PD-related infections and technique failures are still common in PD therapy. The outcomes of home visits on reducing PD-related infections and improving technique survival, especially for the patients lived in rural areas, are unknown. METHODS: From January, 2010 to December 1, 2013, we started home visits to patients under PD treatment in Chia-Yi County in Taiwan. In this observational cohort study, PD-related infections were defined according to the guideline of International Society for Peritoneal Dialysis (ISPD). PD technique failure was defined as death or a switch to hemodialysis for more than 60 days. Factors, which may affect the outcome of PD-related infections and technique survival were analyzed. RESULTS: A total of 66 patients were included in the study. The patients had a mean age of 55.5±13.8 years; among them 53% were men. Pre-home visit infections were found at a higher rate among patients in the age group of 63.5±11.7 than those of 51.9±13.2 years. By negative binomial Poisson regression analysis, we found a significant reduction of incidence rate ratios in exit site (IRR: 0.11, ＂P＂=0.03) and total PD-related infections (IRR: 0.52, ＂P＂=0.01) after home visit. Additionally, those with repeated infections, 50% lived in solitary and none of them had a college degree. Conversely, among those without repeated infections, 20% lived in solitary and 30% had a college degree, showing that repeated infections correlated with patients' living styles and educational levels. Home visits were found to benefit technique survival additionally. CONCLUSION: Home visits effectively reduce PD-related infections and improve technique survival among patients with previous infections. Family supports and educational levels seem crucial to improvement of infection control after home visits.