Assisted Peritoneal Dialysis. Experience in a French Renal Department

Abstract

Background The French healthcare system offers the possibility of increasing the use of peritoneal dialysis (PD) by involving in patient care nurses who work in the private system. Objective This study was conducted to evaluate the impact of a private home-nurse network on one dialysis program. Methods This was a retrospective study of 239 dialysis patients who started dialysis in our center between 1 January 1998 and 31 December 2003. Results Of these 239 patients, 142 were treated with hemodialysis and 97 with PD during the study period. Among the PD patients, 36 of 97 were treated with assisted PD and 61 of 97 with self-care PD. Assisted-PD patients were older (74 ± 10 vs 52 ± 18 years, p < 0.001) and presented more comorbidity (Charlson Comorbidity Index 7 ± 2.5 vs 4.3 ± 2.4, p < 0.05) compared with self-care patients. Continuous ambulatory PD was the modality of choice in the assisted group (32/36). Assisted patients were frequently hospitalized (31/36); actuarial survival free of hospitalization at 6 months was 46%. Patients with nurse assistance had a high risk of peritonitis (actuarial survival free of peritonitis: 52% at 1 year). Technique survival was 85% at 6 months and 58% at 1 year. Actuarial patient survival was 90% at 6 months and 83% at 1 year. Conclusion Assisted PD enables increased use of PD in incident dialysis patients. However, in view of the comorbidities of the assisted-PD patients, the need for frequent hospitalization has to be taken into account in such a program.

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

“…However, our results show that the vast majority of elderly patients on PD in France are treated by CAPD. Most of the time, assisted CAPD patients are treated with a non-disconnectable UV Flash device in order to save time for the nurse at the patient's home [42]. Surprisingly, gram-negative peritonitis was not over-represented in our study.…”

Prevalence of Cognitive Impairment among Peritoneal Dialysis Patients, Impact on Peritonitis and Role of Assisted Dialysis

“…Thirdly, such results could be due to the renal specialist nurse being more likely to assign patients with CI to the assisted group during assessment of patients' ability to perform PD (despite not knowing the MoCA results). Previous studies on comparing self-care and assisted-PD patients found that there was no difference in the risk of technique failure or overall survival (15)(16)(17)(18). Another possible explanation is that self-care PD patients with CI can have similar outcomes to self care non-CI patients if adequate training is provided.…”

Making Assisted Peritoneal Dialysis a Reality in the United States

“…Barriers may occur at any age but are more likely in older patients. For example, the mean age of patients requiring assisted PD ranges from 71 to 79 years in published reports (1,2). Physical barriers include reduced physical strength to lift PD bags, reduced dexterity to make connections, and reduced vision/hearing to respond to alarms and program the cycler (3).…”