Abstract
Background
Chronic kidney disease (CKD) represents a growing public health challenge worldwide, particularly in countries with a medium sociodemographic index such as the Dominican Republic (DR), where both the incidence and prevalence of CKD have shown a sustained increase. In response, the DR government launched a national peritoneal dialysis (PD) program in 2013 to expand access to kidney replacement therapy (KRT).
Methods
A retrospective analysis was conducted on the development and implementation of the national continuous ambulatory peritoneal dialysis (CAPD) program over ten years. The model was structured around three pillars: (1) a multidisciplinary team comprising nephrology, nursing, nutrition, psychology, and social work; (2) dedicated infrastructure for PD delivery; and (3) a management system driven by standardized processes and protocols, aligned with ISO certification standards. Patient care involved comprehensive baseline assessments, structured training, monthly follow-up, routine retraining, and home evaluations. Program performance was monitored through predefined clinical indicators.
Results
Since the implementation of the program, the PD penetration in DR increased from 2.7% to 22.4%, reaching 1118 patients by the end of 2024. This growth reflects the program's ability to improve access to KRT through a centralized and standardized care model. This model not only facilitated consistency in care delivery across participating centers but also enhanced the growth of PD.
Conclusions
The 10-year experience of the national PD program in the DR provides evidence for the feasibility and effectiveness of a standardized, patient-centered, and multidisciplinary PD program. The implementation of this program has significantly increased access to kidney replacement therapies and driven the sustained growth of KRT in the DR and provides a scalable model for the implementation of national PD initiatives in similar contexts.
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Supplementary Material
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