Patient Knowledge and Adherence to Practices Related to Continuous Ambulatory Peritoneal Dialysis: A Study at a Tertiary Care Hospital in Sri Lanka

Abstract

Background: Continuous ambulatory peritoneal dialysis (CAPD) is a potentially cost-effective renal replacement therapy underutilised in developing countries. Undesirable outcomes in CAPD patients are often linked to poor knowledge and adherence to treatment practices. Objectives: To explore patients’ knowledge, adherence to treatment practices and identify factors associated with outcomes in CAPD patients at a tertiary care institution in Kandy district. Methods: A cross-sectional study with a concurrent observational component was conducted among 25 consenting adult patients undergoing CAPD for end-stage renal disease at Teaching Hospital Peradeniya. A validated interviewer-administered questionnaire evaluated knowledge using 60 items (total score: 60 points) covering diet, exchange procedure, peritonitis, exit-site infections, and general. Adherence to practices was directly observed during a CAPD session using a 60-item checklist focused on exchange procedure and exit-site care. Medical record review identified outcomes (peritonitis, exit-site infections, and unscheduled hospitalization). Associations between socio-demographics and outcomes with knowledge and practice scores were analyzed using Chi-squared test and Mann-Whitney U-test. Association between knowledge and practice was assessed using Spearman correlation. Significance was assessed at alpha 0.05. Results: Participants were on average 55±15.2 years, undergoing CAPD for 1.29±0.78 years and 11 were females. Mean±SD knowledge and practice scores achieved were 22.4±5.81 and 52.05±5.40, respectively. Peritonitis, exit-site infections, unplanned hospitalizations, and any adverse outcome occurred at rates of 0.25, 0.31, 0.28, and 0.84 episodes per patient-year, respectively. Outcomes were independent of age, sex, educational level, family income, requirement for assistance, knowledge score, and practice score. The practice score was positively and significantly correlated with knowledge score (R=0.476, p=0.025). Neither score was associated with duration of treatment. Conclusions: Despite satisfactory CAPD practices, knowledge gaps exist, highlighting the need for repeated reinforcement. Satisfactory practices likely contributed to low levels of unfavorable outcomes. Bridging knowledge gaps may improve outcomes further.