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A trans-Tasman clinical trial led by University of Queensland researchers has marked a key step towards easing the kidney dialysis crisis in Australia and New Zealand, with the TEACH-PD peritoneal dialysis trial testing whether standardized training could reduce infection rates.
What the TEACH-PD Peritoneal Dialysis Trial Set Out to Test
UQ researchers led a large-scale trial to test whether a standardized peritoneal dialysis program called TEACH-PD could reduce infection compared with existing patient training. Professor David Johnson, of UQ’s Australasian Kidney Trials Network and Frazer Institute, said kidney dialysis systems in Australia and New Zealand were at breaking point, with an urgent need to find ways to keep patients with kidney failure out of hospital settings.
A First-of-Its-Kind Randomized Trial
“Our study is the first randomised trial to examine if an internationally guided peritoneal dialysis training curriculum reduces infections compared with existing local training practices,” Johnson said. “This was a well-executed trial that has reinforced peritoneal dialysis, a home-based treatment, as an effective option to ease the load on struggling hospital-based dialysis units.”
Why the TEACH-PD Peritoneal Dialysis Trial Matters for Healthcare Costs
Peritoneal dialysis is a treatment option for patients with kidney disease that has progressed to the point where kidneys can no longer function effectively on their own. The treatment can be administered by a patient at home following training from a healthcare provider, a method estimated by Deloitte Access Economics to save the Australian taxpayer $67,750 per patient annually compared with hospital-based dialysis units.
Rapidly Growing Demand for Dialysis
Deloitte Access Economics estimates kidney disease dialysis demand will grow by 42% between 2021 and 2030. “We are facing a hospital-based dialysis capacity crisis that is putting patients’ lives at risk,” Johnson said. “Hospitals are having to ration dialysis care and reduce treatment hours to accommodate more patients in a single unit, while managing significant staff shortages.”
The Scale of the TEACH-PD Peritoneal Dialysis Trial
The study recruited 1,462 patients with kidney failure and healthcare professionals from 42 peritoneal dialysis training centres across Australia and New Zealand. TEACH-PD was delivered to 667 participants, with findings compared against 795 participants who undertook existing training.
What Researchers Found About Training’s Impact on Infection
Professor Yeoung Jee Cho of UQ’s Australasian Kidney Trials Network and Frazer Institute said TEACH-PD is a landmark clinical trial that provides critical evidence on the role of training. “For the first time, our study has demonstrated that the way in which patients and nurses are trained has a measurable impact on PD-related infections,” Cho said.
Nuanced Results From the TEACH-PD Peritoneal Dialysis Trial
“The TEACH-PD intervention was associated with a small increase in infection risk, but the findings offer invaluable insights into the complexity of training delivery,” Cho said. “Our learnings will help shape safer, more effective training programs, while minimising unintended harm.”
Why Peritoneal Dialysis Remains Underutilized Globally
“This is important, as peritoneal dialysis is effective but underutilised worldwide, of 4.5 million people on dialysis for kidney failure, only 11 per cent use the home-based treatment,” Cho said, highlighting a significant gap between the treatment’s potential benefits and its actual global adoption.
What Made the TEACH-PD Peritoneal Dialysis Trial Successful
Professor Josephine Chow, of Western Sydney University’s School of Nursing & Midwifery, and co-principal investigator on the project, said strong engagement from PD nurses and patients was a key success of the trial. “This high level of engagement will be critical in supporting the translation of our findings into clinical practice.”
What Comes Next
A post-trial evaluation was underway to investigate improvements. The research was published in eClinicalMedicine, with additional collaborators including Professor Neil Boudville of The University of Western Australia, Professor Suetonia Green of the University of Otago, and Associate Professor Rachael Walker of the University of Auckland.
What This Means for the Future of Home-Based Dialysis
Given the unexpected finding that the standardized TEACH-PD curriculum was associated with a small increase in infection risk rather than a reduction, this TEACH-PD peritoneal dialysis trial underscores how complex training delivery can be, even when guided by internationally recognized best practices. As researchers conduct their post-trial evaluation to investigate improvements, the insights gained may prove valuable for refining future training programs, particularly given the scale of the global gap between peritoneal dialysis’s clinical potential and its current 11% utilization rate among dialysis patients worldwide.
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