Standardised training for reducing peritoneal dialysis-related infection: a cluster randomised controlled study

Background Peritoneal dialysis is a widely used treatment for kidney failure; however, peritoneal dialysis-related infections (exit-site, tunnel infection, peritonitis) occur frequently. The effect of standardised nurse and patient training on peritoneal dialysis infections is uncertain. The aim of this study was to determine whether implementing an international guideline-based standardised training curriculum for nurse trainers and new peritoneal dialysis patients reduces the risk of peritoneal dialysis-related infections compared with existing local training practices. Methods Targeted Education ApproaCH to improve Peritoneal Dialysis (TEACH-PD) was a pragmatic, investigator-initiated, cluster-randomised controlled trial conducted in Australia and New Zealand. Adult patients 18 years of age or older with kidney failure who required training for incident peritoneal dialysis treatment and who were able to provide written informed consent were eligible. Clusters were randomised 1:1 to either the standardised training curriculum or usual care. Participant data and infection outcomes were routinely collected in national patient registries. The primary outcome was time to first peritoneal dialysis-related infection (exit site infection, tunnel infection, or peritonitis). Secondary outcomes were the first of each individual infection type in the primary composite outcome, catheter removal, haemodialysis transfer, all-cause death and quality of life. This trial was registered with ClinicalTrials.gov, number NCT03816111. Findings Between 22 July 2019 and 29 September 2023, 42 clusters were randomised: 21 to the standardised training group and 21 to the usual care group. Overall, 1462 incident peritoneal dialysis patients were included; 667 were assigned to the standardised training group and 795 to the usual care group. A peritoneal dialysis-related infection occurred in 296 of 667 patients in the standardised training group and 297 of 795 patients in the usual care group (sub-hazard ratio 1.230, 95% confidence interval [CI] 1.004–1.507, p=0.0457). Secondary outcomes were similar in the two groups. Interpretation Among patients commencing peritoneal dialysis, the use of a standardised training curriculum for nurses and patients based on the International Society for Peritoneal Dialysis guidelines increased peritoneal dialysis-related infection. Implementation-focused research is needed to identify which elements of training require standardisation and where individualisation is most beneficial to support safe, sustainable and patient-centred peritoneal dialysis care. Funding The TEACH-PD trial is funded by MRFF Clinical Trials Activity: Rare Cancers, Rare Diseases and Unmet Need Grant Opportunity; National Health & Medical Research Council BEAT-CKD Program Grant; Health Research Council of New Zealand grant; Metro South Health Research Support Scheme Research Fund—Health System and Health Economics Project Grant; Queensland Health; South Western Sydney Research Small Grant Scheme; International Society for Peritoneal Dialysis; Translational Research Institute Australia; Amgen and Baxter Healthcare (Vantive).

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EClinicalMedicine
Published
2026-07-23
DOI
https://doi.org/10.1016/j.eclinm.2026.104089
Primary Topic
Dialysis and Renal Disease Management
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article
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article

Standardised training for reducing peritoneal dialysis-related infection: a cluster randomised controlled study

Charani Kiriwandeniya, Melinda Tomlins, Rachel Haselden, Ken‐Soon Tan et al.
EClinicalMedicine
Dialysis and Renal Disease Management
article

Standardised training for reducing peritoneal dialysis-related infection: a cluster randomised controlled study

Charani Kiriwandeniya, Melinda Tomlins, Rachel Haselden, Ken‐Soon Tan, Liz Berry, Michaela Kelleher, Gabor Mihala, Cherie Forbes, Sally Fox, Harris Hakim, Jenny Franco, Suda Swaminathan, Genevieve Z. Steiner, Donna Reidlinger, Jessica Kasza, Yeoungjee Cho, Ruth Campbell, David Wayne Johnson, Ramya Movva, Rosemary Simmonds, Ashik Hayat, Blair Donkin, Balaji Jagannathan, Laura Robison, Glenda Rayment, Emad Maher, Morgan Park, Roy Cherian, Andrea Valks, Misa Matsuyama, Kirsten Howard, Josephine Sau Fan Chow, Vanessa Edwards, Bernadette Buisman, Trudi Fuge, Lee Sw, Megan Upjohn, Mathew Mathew, Hawley Cm, Elaine M. Pascoe, Ana E. Figueiredo, Susana San Miguel, Sanjeev Baweja, Sue Curry, David Voss, Catherine Blackamore, Fiona Brown, T L Nguyen, Suetonia Green, Rachael C. Walker, Kylie Pegg, Mary Bodilsen, Natalie Grainer, Stella Green, Liza Vergara, Diana Rose Leary, Anna Lee, Melisa Mlambo, Caroline Gilmore, Christine Somerville, Cheryle Kiwi, Samantha McCabe, Jamie Kenrick-Jones, Bindu Sunny, Sharon Pitchford, Matthew D. Jose, Neil Boudville, Murthy Divi, Kerry Yaxley, Portia Sena, Annie Reynolds, Maria Dararoay, Kathryn Anderson, Penny Hill, Richard Singer, Carolyn Armstrong, Heather Ferguson, Soana Schaaf, Matthew Davies, Andrea Blanco, Kamal Sud, Jazmine Tuivaiave, Carolyn Sanders, Courtney Ruzgys, Tracey Putt, Stephanie Fisk, Tim Spicer, Pushparaj Velayudham, Reena Gounder, Allison Jaure, Jo-Anne Moodie, Lisa Feltell, Marylin Aday, Jane Ruane, Martin Howell, Gloria Ruwhiu, Hayley Candler, Claire Reed, Walaa WM. Saweirs, Keri-Lu Equinox
article en

Abstract

Background Peritoneal dialysis is a widely used treatment for kidney failure; however, peritoneal dialysis-related infections (exit-site, tunnel infection, peritonitis) occur frequently. The effect of standardised nurse and patient training on peritoneal dialysis infections is uncertain. The aim of this study was to determine whether implementing an international guideline-based standardised training curriculum for nurse trainers and new peritoneal dialysis patients reduces the risk of peritoneal dialysis-related infections compared with existing local training practices. Methods Targeted Education ApproaCH to improve Peritoneal Dialysis (TEACH-PD) was a pragmatic, investigator-initiated, cluster-randomised controlled trial conducted in Australia and New Zealand. Adult patients 18 years of age or older with kidney failure who required training for incident peritoneal dialysis treatment and who were able to provide written informed consent were eligible. Clusters were randomised 1:1 to either the standardised training curriculum or usual care. Participant data and infection outcomes were routinely collected in national patient registries. The primary outcome was time to first peritoneal dialysis-related infection (exit site infection, tunnel infection, or peritonitis). Secondary outcomes were the first of each individual infection type in the primary composite outcome, catheter removal, haemodialysis transfer, all-cause death and quality of life. This trial was registered with ClinicalTrials.gov, number NCT03816111. Findings Between 22 July 2019 and 29 September 2023, 42 clusters were randomised: 21 to the standardised training group and 21 to the usual care group. Overall, 1462 incident peritoneal dialysis patients were included; 667 were assigned to the standardised training group and 795 to the usual care group. A peritoneal dialysis-related infection occurred in 296 of 667 patients in the standardised training group and 297 of 795 patients in the usual care group (sub-hazard ratio 1.230, 95% confidence interval [CI] 1.004–1.507, p=0.0457). Secondary outcomes were similar in the two groups. Interpretation Among patients commencing peritoneal dialysis, the use of a standardised training curriculum for nurses and patients based on the International Society for Peritoneal Dialysis guidelines increased peritoneal dialysis-related infection. Implementation-focused research is needed to identify which elements of training require standardisation and where individualisation is most beneficial to support safe, sustainable and patient-centred peritoneal dialysis care. Funding The TEACH-PD trial is funded by MRFF Clinical Trials Activity: Rare Cancers, Rare Diseases and Unmet Need Grant Opportunity; National Health & Medical Research Council BEAT-CKD Program Grant; Health Research Council of New Zealand grant; Metro South Health Research Support Scheme Research Fund—Health System and Health Economics Project Grant; Queensland Health; South Western Sydney Research Small Grant Scheme; International Society for Peritoneal Dialysis; Translational Research Institute Australia; Amgen and Baxter Healthcare (Vantive).

EClinicalMedicineVol. 98
University of Technology Sydney (AU), The University of Sydney (AU), University of Tasmania (AU), Statistics New Zealand (NZ), Translational Research Institute (AU), Ministry of Health (NZ), The Royal Melbourne Hospital (AU), University of Auckland (NZ), The University of Western Australia (AU), Launceston General Hospital (AU), Middlemore Hospital (NZ), Cairns Hospital (AU), Princess Alexandra Hospital (AU), Government of New Zealand (NZ), Shoalhaven District Memorial Hospital (AU), Sir Charles Gairdner Hospital (AU), Royal Hobart Hospital (AU), UNSW Sydney (AU), Auckland University of Technology (NZ), Northland District Health Board (NZ), Education New Zealand (NZ), Jena University Hospital (DE), Ingham Institute (AU), New Zealand Christians in Science (NZ), Hunter New England Local Health District (AU), South Western Sydney Local Health District (AU), Pontifícia Universidade Católica do Rio Grande do Sul (BR), Monash University (AU), Western Sydney University (AU), University of Otago (NZ)
International Society for Peritoneal Dialysis, Metro South Health, Translational Research Institute Australia, Baxter Healthcare Corporation, Amgen Australia, National Health and Medical Research Council, Health Research Council of New Zealand
Openalex Percentile: Top 9%
Dialysis and Renal Disease Management
DOIOpen Access PDFOpenAlex
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