Assisted peritoneal dialysis: a feasible KRT modality for frail older patients with end-stage kidney disease (ESKD)

Abstract

Assisted PD is used as an alternative option for the growing group of frail, older ESKD patients unable to perform their own PD. This study was undertaken to investigate the outcomes of assisted PD in older patients by comparing assisted PD patients with self-care PD patients. This study included all patients aged 70 and above who started on PD in our hospital from 2009 to 2018. Patients were followed up until death, PD cessation or to the end of the study (December 31, 2019). Risk factors associated with mortality, peritonitis and technique failure were evaluated using both cause-specific hazards and subdistribution hazards models. 180 patients were enrolled, including 106 (58.9%) males with a median age of 77.5 (77.2–81.2) years. Among the 180 patients, 62 patients (34.4%) were assisted. Patients on assisted PD group were older, more likely to be female, more prevalent in DM and CVD, with a higher Charlson score than patients undergoing self-care PD (P all < 0.05). In the multivariable analysis, assisted patients had a comparable patient survival and peritonitis-free survival compared to self-care PD patients either in the Cox or in the FG models. According to a Cox model, the use of assisted PD was associated with a lower risk of technique failure (cs-HR 0.20, 95% CI 0.04–0.76), but the association lost its statistical significance in the Fine and Gray model. Our results suggest that assisted PD could be a safe and effective KRT modality for older ESKD patients who need assistance.

Late Dialysis Modality Education Could Negatively Predict Peritoneal Dialysis Selection

“…In this situation, assisted PD by trained staff or family members has recently attracted a lot of attention. Several studies demonstrated that assisted PD presented equality or superiority in mortality and peritonitis risk compared with self-care PD [ 37 , 38 ]. Furthermore, assisted PD can be beneficial in risk of transfer to HD, especially to frail patients with low exercise capacity [ 37 , 39 ].…”

“…Several studies demonstrated that assisted PD presented equality or superiority in mortality and peritonitis risk compared with self-care PD [ 37 , 38 ]. Furthermore, assisted PD can be beneficial in risk of transfer to HD, especially to frail patients with low exercise capacity [ 37 , 39 ]. The Frail and Elderly Patient Outcomes on Dialysis study demonstrated that the quality of life of elderly patients on assisted PD was similar to those of patients receiving in-center HD, and treatment satisfaction was higher on assisted PD [ 40 ].…”

Assisted peritoneal dialysis: strategies and outcomes

“…They can offer helper-assisted CAPD with three different types of helpers: family members, domestic helpers, and nursing home staff (who are semiskilled health care assistants) [ 27 ]. Some other Chinese reports described the use of family-member or domestic worker paid by the employer, as helpers [ 28 ], selected according to education, with no health care background required, only able to read and write [ 29 ].…”

Assistierte Peritonealdialyse bei älteren und gebrechlichen Patienten

“…der peritonitisfreien Zeit. 55,6 % der Patienten verstarben im Beobachtungsintervall, 8,9 % wechselten zur HD und bei 30 % erfolgte die Therapie weiterhin mittels der PD 14 .…”