Facility-based educational systems and peritonitis incidence in peritoneal dialysis: findings from a nationwide survey in Japan

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Abstract
Background There have been no clear recommendations regarding the optimal timing, setting, content, and duration for peritoneal dialysis (PD) education. This nationwide survey aimed to examine current PD educational practices across Japanese facilities and explore factors associated with the incidence of PD-related peritonitis. Methods Eligible facilities were institutional members of the Japanese Society for Peritoneal Dialysis. The questionnaire consisted of five sections covering facility characteristics, facility-level peritonitis profiles, PD education, peritonitis prophylaxis, and re-education. Associations between PD practices and the incidence of PD-related peritonitis were examined using linear and logistic regression analyses. Results A total of 194 facilities were included between November 2024 and May 2025. The median peritonitis incidence rates in 2023 and 2024 were 0.18 and 0.20 episodes/patient-year, respectively. Regression analyses showed that an annual training frequency of two or more sessions for education staff, earlier initiation of PD education (before catheter insertion vs. around PD initiation), more frequent visits during the first month after PD initiation (once every 1–2 weeks vs. once every 3–4 weeks), and routine patient re-education were associated with lower incidence of peritonitis or higher achievement of the target incidence rate of < 0.4 episodes/patient-year. Conclusions Regular training for patient educators, early initiation of patient education before catheter insertion, and follow-up with re-education after PD initiation were associated with lower rates of PD-related peritonitis.

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