Ten-year implementation of a National Peritoneal Dialysis Program in the Dominican Republic: A retrospective study.

Abstract

BackgroundChronic kidney disease (CKD) represents a growing public health challenge worldwide, particularly in countries with a medium sociodemographic index such as the Dominican Republic (DR), where both the incidence and prevalence of CKD have shown a sustained increase. In response, the DR government launched a national peritoneal dialysis (PD) program in 2013 to expand access to kidney replacement therapy (KRT).MethodsA retrospective analysis was conducted on the development and implementation of the national continuous ambulatory peritoneal dialysis (CAPD) program over ten years. The model was structured around three pillars: (1) a multidisciplinary team comprising nephrology, nursing, nutrition, psychology, and social work; (2) dedicated infrastructure for PD delivery; and (3) a management system driven by standardized processes and protocols, aligned with ISO certification standards. Patient care involved comprehensive baseline assessments, structured training, monthly follow-up, routine retraining, and home evaluations. Program performance was monitored through predefined clinical indicators.ResultsSince the implementation of the program, the PD penetration in DR increased from 2.7% to 22.4%, reaching 1118 patients by the end of 2024. This growth reflects the program's ability to improve access to KRT through a centralized and standardized care model. This model not only facilitated consistency in care delivery across participating centers but also enhanced the growth of PD.ConclusionsThe 10-year experience of the national PD program in the DR provides evidence for the feasibility and effectiveness of a standardized, patient-centered, and multidisciplinary PD program. The implementation of this program has significantly increased access to kidney replacement therapies and driven the sustained growth of KRT in the DR and provides a scalable model for the implementation of national PD initiatives in similar contexts.