Virtual Care Utilization and Peritonitis Risk in Rural and Indigenous Peritoneal Dialysis Patients

Résumé fourni par la source

Introduction Peritoneal dialysis (PD) provides an essential home-based kidney replacement therapy, particularly for rural and Indigenous populations with limited access to in-center hemodialysis. Trust, continuity, and technical proficiency are critical for safe PD care. The COVID-19 pandemic accelerated virtual care delivery, coinciding with increased PD-associated peritonitis. Methods We conducted a retrospective cohort study (2021–2023) with an embedded qualitative component at a regional hospital in Northern British Columbia, Canada. Demographic, clinical, and virtual care data were extracted from the provincial databases and patient charts. Peritonitis episodes were classified using structured Root Cause Analysis. Multivariable logistic regression assessed associations between patient factors and peritonitis risk. Semi-structured interviews with 12 PD patients explored perceptions of trust, training adequacy, and care continuity. Results Among 45 adult PD patients (mean age 63.5 ± 12.1 years), 78 peritonitis episodes occurred. Patients from rural Indigenous communities represented 33.3% of the cohort but accounted for 70.5% of episodes. Root Cause Analysis attributed 63.8% of episodes to technique failure, 19.1% to acute events, and 17.0% to psychosocial stressors. Peritonitis was associated with residence in an Indigenous community (OR 2.45, 95% CI 1.01–5.94, p=0.049), high virtual care exposure (≥85% of visits; OR 2.85, 95% CI 1.19–6.84, p=0.019), and technique failure (OR 3.12, 95% CI 1.42–6.84, p=0.005). Qualitative themes included diminished trust, inadequate hands-on training, and perceived clinical detachment. Conclusion High virtual care exposure was associated with increased risk of peritonitis, particularly among patients in rural Indigenous communities. Adapting PD models to strengthen trust, hands-on training, and cultural safety may improve outcomes.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.