Towards SDG3: Empowering Non-Nephrologists to Perform Peritoneal Dialysis in District Settings

Abstract

BackgroundSDG3 stipulates good health and well-being for all. Dialysis has remained a specialized skill for nephrologists. In settings without nephrologists, many die from Acute Kidney Injury (AKI).  In 2014, the International Society of Nephrology (ISN) launched the 0by25 initiative for zero death from AKI globally. In this paper, we report on training of district health practitioners in the performance of PD for AKI using improvised means. Methods  PD training workshops with hands-on experienced were organized in 7 regional capitals in Ghana. Topics taught included: Recognition of a child with AKI Principles of PD Indications for dialysis therapy and writing of PD prescription Technique in insertion of PD catheter plus video exhibit Catheters suitable for use as PD catheters Fluids suitable for use as dialysate Performing the PD exchanges Complications related to PD Infection prevention in PD. Results A total of 150 health workers made up of 131 Doctors or Physician Assistants and 19 nurses were trained across Ghana. Feedback from trainees indicates that 42 PDs have been carried out in 7 district hospitals. 25 (59.5%) of the 42 dialyzed children survived and recovered renal function. Conclusion  It is possible to build the capacity of non-nephrologists to identify AKI and institute PD in district level hospitals so SDG3 could be realized. Such achievement will also help to realize the ISN 0by25 initiative especially in resource-limited settings where nephrology expertise is lacking.