Successful use of continuous ambulatory peritoneal dialysis in octogenarians

Jagose, Jinni T; Afthentopoulos, I E; Shetty, Anupkumar; Oreopoulos, Dimitrios G.

doi:10.1007/bf01879285

Cited by 15 publications

(26 citation statements)

References 9 publications

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“…Exit-site infection was less common probably because of less physical activity [12,13]. The hospitalization rate is reported to be higher in the elderly than in younger patients [7]. Our average hospital stay was 22.6 patient days, which is slightly higher than reported by others [14][15][16]; this is explainable because our patients had more co-morbid conditions at the start of dialysis.…”

Section: Discussioncontrasting

confidence: 51%

“…In agreement with the published data, we found that the leading cause of renal failure in elderly was hypertension and diabetes. As in other series [2,5], majority of patients had three or more co-morbid conditions; hypertensive heart disease, coronary artery disease, peripheral vascular disease and malnutrition were the most common co-morbid illnesses [7,9]. Malnutrition has been reported to be commoner than in the younger PD population and is correlated with patient survival [10].…”

Section: Discussionmentioning

confidence: 96%

“…Although there are a few reports on peritoneal dialysis in 7th, 8th and 9th decades of life [5][6][7][8], there is no literature regarding chronic PD in patients in the 10th decade of life (!90 years). In this paper we review our center's experience in terms of patient survival, technique survival, complications and quality of life in patients who are receiving PD at the age of 90 years and above.…”

Section: Introductionmentioning

confidence: 99%

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Chronic peritoneal dialysis in the tenth decade of life

et al. 2004

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In this retrospective study we present our experience with chronic peritoneal dialysis in nine patients with ESRD in their 10th decade of life (> or =90 years) at the Toronto Western Hospital. A family member or a private nurse assisted all patients in dialysis procedure. The co-morbid illnesses, survival, hospitalizations and complications related or unrelated to peritoneal dialysis were reviewed. Four patients started dialysis before and five after their 90th birthday, their mean age was 90.61+/-4.04 years. All patients had three or more co-morbid illnesses at the start of dialysis. Total duration of PD treatment was 210 patient months with a median duration of 25 months (range 4-68 months). Of the nine patients, four died after a mean follow up of 38.5 months on dialysis. Of the remaining five, one was transferred to hemodialysis after remaining for 10 months on peritoneal dialysis and the other four are continuing on PD for a mean duration of 9.25 months. Peritonitis (1/13.4 patient months) and exit site infection (1/100.5 patient months) responded to treatment. Hospitalization rate was one admission per 2.5 patient years. Most often, the cause of hospitalization was unrelated to PD, e.g., cardiovascular events, pneumonia and peripheral vascular disease etc. Patient survival at 1, 3 and 5 years was 88%, 58% and 24% respectively. The technique survival was 69%, 47% and 23% at 1, 3 and 5 years respectively. We conclude that continuous peritoneal dialysis is a safe and suitable treatment even in nonagenarians (> or =90 years) ESRD patients.

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Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Chronic peritoneal dialysis in the tenth decade of life

et al. 2004

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“…This trend is increasing the demand for kidney replacement therapy. Peritoneal dialysis is considered an appropriate therapy for elderly and diabetic patients (3,(15)(16)(17)(18). However, it is well-known that older and diabetic dialysis patients are more likely to have weaker eyesight, impaired physical abilities, and cognitive dysfunction, all of which are often regarded as major contraindications to performing PD.…”

Section: Discussionmentioning

confidence: 99%

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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“…33,No. 3 A BRAZILIAN EXPERIENCE IN AAPD the public transportation cost (approximately US$150 per month).…”

Section: Pdimentioning

confidence: 99%

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

Franco

Fernandes

Ribeiro³

et al. 2012

Perit Dial Int

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Introduction Automated assisted peritoneal dialysis (AAPD) has been shown to be successful as renal replacement therapy for elderly and physically incapable end-stage renal disease (ESRD) patients. In early 2003, a pioneer AAPD program was initiated at GAMEN Renal Clinic in Rio de Janeiro, Brazil. Objective We evaluated the results of an AAPD program offered as an option to elderly ESRD patients with physical or cognitive debilities or as last resort to patients with vascular access failure or hemodynamic instability during hemodialysis. Methods A cohort of 30 consecutive patients started AAPD from January 2003 to March 2008 and was followed to July 2009. Demographics, clinical and laboratory parameters, causes of death, and patient and technique survival were analyzed. Results Median age of the patients was 72 years (range: 47 – 93 years), with 60% being older than 65. The Davies score was greater than 2 in 73% of patients, and the Karnofsky index was less than 70 in 40%. The overall peritonitis rate was 1 episode in 37 patient–months. The total duration of AAPD ranged from 3 to 72 months. Patient survival was 80% at 12 months, 60% at 24 months, and 23.3% at 48 months. The most common cause of death was cardiovascular problems (70%). Conclusions In this clinical observational study, AAPD fulfilled its expected role, offering an opportune, reliable, and effective homecare alternative for ESRD patients with no other renal replacement therapy options.

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Successful use of continuous ambulatory peritoneal dialysis in octogenarians

Cited by 15 publications

References 9 publications

Chronic peritoneal dialysis in the tenth decade of life

Chronic peritoneal dialysis in the tenth decade of life

Experiences with Assisted Peritoneal Dialysis in China

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

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