Assisted peritoneal dialysis as a method of choice for elderly with end-stage renal disease

Abstract

In the last two decades, most developed countries have seen a continuous growth in the number of elderly patients with end-stage renal disease commencing renal replacement therapy. Despite the many advantages that peritoneal dialysis (PD) offers to elderly patients with ESRD, it is still underutilized in older patients. Older patients are much more vulnerable to the problems associated with aging, which may affect their level of independence and their long-term prognosis. Those patients have physiological changes related to aging and common health problems such as anxiety, depression, dementia, visual impairment, and cognitive impairment, all of which interfere with self-performing PD. Assistance with home-care nurses and assistance by a family member may overcome this problem. Some old but also more recent literature data justifies the idea that assisted PD may significantly contribute to increase the overall number of elderly patients who can be treated with PD at home. With assisted PD, free choice can be offered to patients with high comorbidity index who cannot perform their peritoneal exchanges by themselves. Automated peritoneal dialysis is the ideal treatment modality for elderly patients with end-stage renal disease who require assistance since this limits home-care nurse visits to only two a day. As expected, the elderly have a higher mortality rate than younger patients treated by assisted PD, but technique failure rate, overall peritonitis rate, and most quality-of-life (QoL) measures are comparable with those of younger patients. Peritoneal dialysis in nursing homes offers treatment for elderly patients without family support. In this regard, automated PD or nightly PD keeps the patient's daytime free for nursing home activities, increases socialization, and enables better rehabilitation that improves their QoL. Although withdrawal from dialysis is more frequent among nursing-home dialysis patients, this high discontinuation rate is not due to dialysis per se but rather to associated social and medical circumstances. Better communication between nursing staff and renal team is crucial for improving staff confidence and will contribute to higher utilization of PD in nursing homes.

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

“…both continuous ambulatory PD and APD, the reimbursement medical fee for the initial training period and the subsequent monthly visits is US$84.86 per patient per month. The extra cost for our AAPD program is basically the nurse assistant's salary (US$560.00 per month), plus For elderly patients with CKD, PD is regarded as a proper and ideal method when assistance is needed for its utilization (30)(31)(32). Among the factors that hamper the choice of PD for elderly patients, those related to the inherent difficulties of advanced age, such as difficulties in learning or performing the procedure, must be considered (14).…”

The challenges of renal replacement therapy and renal palliative care in the elderly

“…This is ironic given that in a recent UK study, scores estimating the intrusion of therapy and quality of life were found to be better in PD patients than in those who received haemodialysis.11 Some Scottish units may promote PD more than others, as judged by the 2.5-fold variation in uptake reported by the Scottish Renal Registry in 2008 ( Figure 3). 4 A recent development has been assisted Automated PD (aAPD) 12,13 , which allows the patient to be treated at night, with a portable machine that pumps fluid in and out of their peritoneal cavity automatically. With aAPD, a fully trained healthcare assistant visits daily -emptying drainage bags, checking drained fluid for cloudiness, setting up the machine for the next treatment, inspecting the catheter exit site and reviewing stocks of treatment fluids and drugs.…”

Incidence of end-stage renal disease in the elderly: a steadily rising global socioeconomic epidemic

“…Also, home dialysis [19] and dialysis in nursing homes with extended care facilities [20] offer treatment for elderly patients without family support; these alternatives may prove to be better options than in-hospital dialysis. Another option for frail and physically dependent elderly patients with ESRD may be assisted automated peritoneal dialysis [21] or assisted peritoneal dialysis for the elderly [22]. These options utilize the assistance of home-care nurses and family members [21,22].…”

“…Another option for frail and physically dependent elderly patients with ESRD may be assisted automated peritoneal dialysis [21] or assisted peritoneal dialysis for the elderly [22]. These options utilize the assistance of home-care nurses and family members [21,22]. Patients with many comorbidities who cannot perform peritoneal exchange by themselves are offered considerable advantages with automated peritoneal dialysis since this limits home-care nurse visits to only two a day.…”

“…Patients with many comorbidities who cannot perform peritoneal exchange by themselves are offered considerable advantages with automated peritoneal dialysis since this limits home-care nurse visits to only two a day. Automated peritoneal dialysis keeps the patient's daytime free for nursing home activities, increases socialization and enables better rehabilitation that improves the quality-of-life of these individuals [22]. Some of these may contribute to the reduction in costs for dialysis patients.…”