Appraising the outcome and complications of peritoneal dialysis patients in self-care peritoneal dialysis and assisted peritoneal dialysis: A 5-year review of a single Saudi center

Abstract

Our objective is to study the outcomes and complications of peritoneal dialysis (PD) including comparison of self-care PD with home-care assisted PD during a five-year period. A retrospective study of PD data at King Saud University-affiliated hospital in Riyadh from January 1, 2009, to December 31, 2013. One hundred and eleven patients were included (female 55%). The average age was 47.4 (1-83) years. Twenty-one (18.91%) patients were on continuous ambulatory PD and 90 (81.08%) on automated PD. The mean time on PD was 23.5 (3-60) months. At the end of five years, 47 (42.34%) patients were continuing on PD, 12 (10.81%) had renal transplant, 33 (29.73%) patients were transferred to hemodialysis, and two (1.8%) patients were transferred to other centers. Seventeen patients died during this period giving a mortality rate of 7.13 deaths/100 patient-year during the five-year period. Six patients died due to cardiovascular causes, while five had sepsis. There was one death each due to prostate cancer, hyperoxaluria, and toxic epidermal necrolysis. Three patients died suddenly at home. Peritonitis rate was one episode/35.28 patient/month or one episode/2.94 patient/year. We compared the results for patients doing the dialysis themselves [56 (50.45%)] "self-care PD" to 55 (49.5%) patients assisted by a family member or other caregivers "assisted PD." We found no significant difference in the incidence of complications, technical outcome, mortality, and peritonitis episodes. However, we found a high prevalence of diabetes mellitus and significant increase in exit site infection in assisted PD. Our study suggests that PD patients in Saudi Arabia have a good overall outcome. Furthermore, assisted PD showed good patient and technique outcome.

A Systematic Review and Jurisdictional Scan of the Evidence Characterizing and Evaluating Assisted Peritoneal Dialysis Models

“…In general, there is a core set of procedural assistance that can be provided by all PD assistants in the characterized models (dark blue box, Figure 2) (45). Home assistants, with the support of patient's family, are trained to provide the most basic assistance with the operation of the PD machine, including machine set-up and dismantling, machine connections, PD bag exchange, and ordering and disposal of PD supplies (46)(47)(48)(49)(50)(51)(52). Home assistants can also provide social support and assistance with activities of daily living (45).…”

“…This model was identified in six jurisdictions: China (46), Kuwait (47), Saudi Arabia (48), Singapore (49), Taiwan (50,51), and Portugal (52). Typically, home assistants received assisted PD training through in-hospital programs or dialysis clinics (46)(47)(48)(49)(50)(51). In all jurisdictions, patients' family members or informal caregivers also provide supplemental assistance for PD, and so undergo the same assisted PD training as home assistants.…”

“…Given this coordinated support, there are no fixed number of visits described for this assisted PD model. Assistance for both the automated PD and continuous ambulatory PD procedures were also provided (46)(47)(48)(49)(50)(51)(52).…”

“…The most common requirement or characteristic described for patients to receive assisted PD is the inability to autonomously perform the PD procedure in their home because of either physical, cognitive, and/or psychosocial barriers ( elderly individuals, or adults with physical disability (14,(34)(35)(36)38,39,(42)(43)(44)46,48,51,52).…”

Health Outcomes and Cost Considerations of Assisted Peritoneal Dialysis: A Narrative Review

“…Sixty two percent required some assistance in managing their PD, of which 34% came from friends/family and 28% from a paid caregiver [8]. This is corroborated in a Saudi cohort where 49.5% of patients required at least some assistance with their dialysis [9]. As a patient’s frailty and cognition deteriorates, the demands placed on the family necessarily increase, which can become overwhelming.…”