Evaluation of A 12-Month Pilot of Long-Term and Temporary Assisted Peritoneal Dialysis

Abstract

♦ BACKGROUND: Peritoneal dialysis (PD) is challenging for patients with functional limitations, and assisted PD can support these patients, but previous reports of assisted PD have not examined the role of temporary assisted PD and had difficulty identifying adequate comparator cohorts. ♦ METHODS: Peritoneal Dialysis Assist (PDA), a 12-month pilot of long-term and temporary assisted PD was completed in multiple PD centers in British Columbia, Canada. Continuous cycler PD (CCPD) patients were identified for PDA by standardized criteria, and service could be long-term or temporary/respite. The PDA program provided daily assistance with cycler dismantle and setup, but patients remained responsible for cycler connections and treatment decisions. Outcomes were compared against both the general CCPD population and patients who met PDA criteria but were not enrolled (PDA-eligible). ♦ RESULTS: Fifty-three PDA patients had an 88% 1-year death- and transplant-censored technique survival that was similar to the general CCPD cohort (84%) and PDA-eligible cohort (86%). The PDA cohort had lower peritonitis rates (0.18 episodes/patient-year vs 0.22 and 0.36, respectively), but higher hospitalization (55% vs 34% and 35%, respectively). Long-term PDA cost approximately CDN$15,000/year in addition to existing dialysis costs. A total of 8/11 respite PDA patients (73%) returned to self-care PD after a median PDA use of 29 days, which costs $1,250/patient. ♦ CONCLUSIONS: Peritoneal Dialysis Assist provides effective support to functionally-limited CCPD patients and yields acceptable clinical outcomes. The program costs less than transfer to HD or long-term care, which represents cost minimization for failing self-care PD patients. Respite PDA provides effective temporary support; most patients returned to self-care PD and service was cost-effective compared with alternatives of hospitalization or transfer to HD.

Impact of Assisted Peritoneal Dialysis Modality on Outcomes: A Cohort Study of the French Language Peritoneal Dialysis Registry

“…A-PD respite can be an effective temporary solution [31]. In contrast, a 12-month pilot program of assisted PD found that technique survival was not different between self-care and assisted PD patients [31]. However, in that study, the definition of assistance was different, as patients (or their families), were responsible for connecting and disconnecting the cycler and other cycler-related tasks in the assisted program.…”

“…In elderly Taiwanese patients, those assisted by a home assistant or a family member had the same risk of peritonitis as autonomous PD patients [15]. The results from a pilot program in Canada showed lower rates of peritonitis in the a-PD group compared to the self-care group suggesting that assisted patients may be given responsibility for making their own connections without increasing rates of peritonitis [31]. However, we found that in the older population, nurse assistance was associated with a lower risk of peritonitis [33].…”

“…It appears important to evaluate regularly the weariness of the patient's family and propose nurse assistance in the event of burnout. A-PD respite can be an effective temporary solution [31]. In contrast, a 12-month pilot program of assisted PD found that technique survival was not different between self-care and assisted PD patients [31].…”

Videodialysis: a pilot experience of telecare for assisted peritoneal dialysis

“…This creation of a "video caregiver" also made it possible not to refer to a family member or professional caregiver, which involves significant social [6] and economic [7,8] costs.…”

“…As regards economic costs, the comparison should be made with Assisted PD carried out by a nurse at home [7,8]. Compared to the latter, VD allows for considerable savings associated with the elimination of travelling costs and the fact that up to 6 patients can be followed at the same time instead of just 1.…”