Prescribing peritoneal dialysis – a new guideline from the International Society of Peritoneal Dialysis

This whole issue of Peritoneal Dialysis International forms a guideline from the International Society for Peritoneal Dialysis (ISPD) that updates its position on prescribing PD. Chaired and edited by Edwina Brown, this series of peer-reviewed papers represent a step change from the traditional small solute-based approach towards one that is more holistic. The ISPD committee considered a range of issues as the work was developed, including greater recognition of the rehabilitative and person-centred nature of care, priorities of both patients and healthcare professionals, impact of multimorbidity, as well as consideration of healthcare context including prescribing in low and middle-income countries. Taking on board these factors, prescribing should be goal-directed and based on shared decision-making between healthcare professionals, patients and their carers. Focus is given to the routine incorporation of quality of life into the assessment of care, preservation of residual renal function, the place of incremental peritoneal dialysis, as well as prescribing for children and for older people with frailty. The final document in the series provides patient perspectives on the guidelines and these cover the challenges of the application of specific components in the reality of healthcare delivery – such as the availability of peer support, or clinician engagement in shared decision-making. The feedback led to direct change in guideline terminology, such as from ‘patient-centred’ to ‘person-centred’, as well as the requirement to consider the prescribing of PD in the context of multimorbidity where PD is only one component of overall care, and guidelines should be ‘for people rather than for diseases’. The patient group would have liked to have had greater involvement earlier in the development of the guideline, rather than reviewing the near-completed work – as part of genuine co-production. The authors of these prescribing guidelines should be congratulated in the breadth and rigour with which they have gone about their work. They challenge the traditional didactic medical model, consider the context of care and give prominence to the patient voice. In places, the guidelines are contentious, and they will undoubtedly stimulate debate. This set of documents represents a key advance in contemporary thinking on the prescribing of PD and provides a powerful resource for our community.