Experiences with Assisted Peritoneal Dialysis in China

Abstract

♦ Objective: About half the patients on peritoneal dialysis (PD) in China need to be assisted by family members or home assistants. We explored whether these patients have a higher risk for peritonitis and death compared with self-care PD patients. ♦ Methods: We prospectively followed 313 incident PD patients until death or censoring. This cohort was divided into assisted and self-care PD groups according to the independence of bag exchange. Data on baseline demographics, Charlson comorbidity index, biochemistry, and residual renal function were recorded during the first 3 -6 months. The outcome variables were first episode of peritonitis and all-cause mortality. ♦ Results: Of the 313 patients in this cohort study, 122 needed assistance in performing bag exchanges (86 from a family member, 36 from a home assistant); the remaining 191 patients did not need assistance. During a follow-up period averaging 44.5 months, 122 patients developed a first episode of peritonitis, and 135 patients died. Compared with patients having a family assistant, those with a home assistant had similar peritonitis-free and survival times, but a higher risk of mortality after adjustments for variables such as age, sex, Charlson comorbidity score, hemoglobin, serum albumin, and residual renal function. Furthermore, compared with self-care patients, assisted patients overall had a similar peritonitis-free time, but a higher risk of mortality, even after adjusting for covariates. ♦ Conclusions: Based on our single-center experience in China, we conclude that assisted PD is a good option for patients with poor self-care ability. This result provides evidence for recruiting patients who need assistance to PD programs in China. Although peritoneal dialysis (PD) has many advantages, such as ease of training and accommodation, simple facilities, and good mobility, the procedure is difficult for patients who are physically disabled or noncompliant. Many studies have demonstrated that self-care difficulties contribute to the underutilization of PD as a kidney replacement therapy (1-3). Accordingly, assisted PD provides a good alternative in Europe. Lobbedez et al. (4) found that, compared with self-care patients, patients with nurse assistance had a higher peritonitis rate and a lower technique survival rate. Povlsen et al. (5) reported a higher risk of peritonitis and mortality in assisted patients than in autonomous patients, all of whom were elderly (>65 years) and receiving automated PD.The reasons that may potentially lead to unfavorable outcomes in assisted PD include inconsistent home care and inadequate training and education for assistants (6). However, in the past few years in our PD patient pool, patients and their home care providers have both been trained at dialysis initiation to be familiar with the procedures of bag exchange, volume control, and blood pressure and glucose monitoring. The major sources of home care providers are stable and provide good training.We conducted the present study to examine the risk factors for perito...

Hospitalization Rates for Patients on Assisted Peritoneal Dialysis Compared with In-Center Hemodialysis

“…Assisted peritoneal dialysis (PD) has emerged as a treatment option for patients who wish to receive home dialysis but have significant barriers to self-care (1)(2)(3)(4)(5)(6)(7). Patients on assisted PD are significantly older and have a higher burden of comorbidity compared with patients on self-care PD, and therefore, adverse events may be common, including hospitalization, peritonitis, and death (8,9).…”

Peritoneal Dialysis-Related Infection in the Older Population

“…Peritonitis-free survival was found to be similar between older patients treated with continuous ambulatory PD and automated PD (21). Three large cohort studies showed that peritonitis rates did not differ between older patients who required assistance for their dialysis exchange and those who could perform the PD exchanges themselves (22)(23)(24). Another study also found that the need for a helper for dialysis exchange, as well as the burden of comorbid condition, does not affect the peritonitis rate amongst older PD patients (12).…”

A Brazilian Experience in Assisted Automated Peritoneal Dialysis: A Reliable and Effective Home Care Approach

“…Verger et al (21) reported that, compared with family-assisted AAPD patients, those assisted a private nurse had a higher risk of developing peritonitis, and recent findings (39) showed that low rates of peritonitis in patients on assisted PD could be explained by the assistance being given by a family member. Nevertheless, in our study, the PD group had no hospitalizations for peritonitis even though most were being attended by a trained nurse assistant.…”