Peritoneal dialysis in elderly patients: report from the French Peritoneal Dialysis Registry (RDPLF)

Castrale, Cindy; Evans, David W.; Verger, Christian; Fabre, Emmanuel; Aguilera, Didier; Ryckelynck, Jean-Philippe; Lobbedez, Thierry

doi:10.1093/ndt/gfp375

Cited by 106 publications

(103 citation statements)

References 40 publications

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“…This result clearly demonstrates that patients who need assistance can receive PD treatment safely in China. However, in accord with results from earlier studies (5,20), our assisted PD patients had a higher mortality rate that could not be explained by their older age, higher comorbidity scores, and lower serum albumin levels. This single copy is for your personal, non-commercial use only.…”

Section: Discussionsupporting

confidence: 91%

Experiences with Assisted Peritoneal Dialysis in China

Zhuo

Yang

et al. 2012

Perit Dial Int

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♦ 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...

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Section: Discussionsupporting

confidence: 91%

Experiences with Assisted Peritoneal Dialysis in China

Zhuo

Yang

et al. 2012

Perit Dial Int

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“…Staff-assisted home dialysis, which involves the delivery of hemodialysis or PD with the aid of visiting nurses who assist to varying degrees in the tasks needed for the patient and/or caregiver to safely and effectively perform maintenance dialysis at home, is well established and supported by governments in Canada, France, Belgium, and Demark, but not in the United States (46)(47)(48)(49). Staff-assisted home dialysis may be particularly attractive over facility-based hemodialysis for elderly, frail patients who would need varying degrees of assistance to perform dialysis at home, thus serving as a palliative approach to dialysis care by avoiding potentially lengthy transportation to and from the dialysis facility and potentially allowing the dose of dialysis to be better tailored to the needs of patients with variable uremic symptoms.…”

Section: Care Delivery Barriersmentioning

confidence: 99%

A Palliative Approach to Dialysis Care

Grubbs

Moss

Cohen

et al. 2014

Clinical Journal of the American Society of Nephrology

132

116

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As the importance of providing patient-centered palliative care for patients with advanced illnesses gains attention, standard dialysis delivery may be inconsistent with the goals of care for many patients with ESRD. Many dialysis patients with life expectancy of <1 year may desire a palliative approach to dialysis care, which focuses on aligning patient treatment with patients' informed preferences. This commentary elucidates what comprises a palliative approach to dialysis care and describes its potential and appropriate use. It also reviews the barriers to integrating such an approach into the current clinical paradigm of care and existing infrastructure and outlines system-level changes needed to accommodate such an approach.

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“…Mean initiation age was 82 years, and 75% of patients required assisted PD (a nurse or family member helps with exchanges) (59-61). Survival was better for those with fewer comorbid conditions (59) and those not requiring assistance, probably reflecting selection bias (59). Strategies such as nocturnal or short daily dialysis may provide advantages similar to those seen with PD, such as gentler ultrafiltration.…”

Section: Choice Of Rrt Hd Versus Peritoneal Dialysismentioning

confidence: 99%

Renal Replacement Therapy in the Elderly Population

Berger¹,

Hedayati

2012

Clinical Journal of the American Society of Nephrology

100

101

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Summary ESRD has become an important problem for elderly patients. The segment of the ESRD population age 65 years or older has grown considerably, and this growth is expected to accelerate in coming years. Nephrologists caring for the elderly with advanced kidney disease will encounter patients with comorbid conditions common in younger patients, as well as physical, psychological, and social challenges that occur with increased frequency in the aging population. These challenging factors must be addressed to help inform decisions regarding the option to initiate dialysis, the choice of dialysis modality, whether to pursue kidney transplantation, and end-of-life care. This article will highlight some common problems encountered by elderly patients with ESRD and review data on the clinical outcomes of elderly patients treated with different modalities of dialysis, outcomes of kidney transplantation in the elderly, and nondialytic management of CKD stage 5.

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Peritoneal dialysis in elderly patients: report from the French Peritoneal Dialysis Registry (RDPLF)

Abstract: PD is a suitable method for elderly patients. In order to increase the rate of PD utilization in elderly patients, the need for the funding of assisted peritoneal dialysis has to be taken into account.

Cited by 106 publications

References 40 publications

Experiences with Assisted Peritoneal Dialysis in China

Experiences with Assisted Peritoneal Dialysis in China

A Palliative Approach to Dialysis Care

Renal Replacement Therapy in the Elderly Population

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