Impact of Assisted Peritoneal Dialysis Modality on Outcomes: A Cohort Study of the French Language Peritoneal Dialysis Registry

Guilloteau, Solène; Lobbedez, Thierry; Guillouët, Sonia; Verger, Christian; Ficheux, Maxence; Lanot, Antoine; Béchade, Clémence

doi:10.1159/000494664

Cited by 28 publications

(26 citation statements)

References 43 publications

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“…The prevalence of patients with end‐stage kidney disease (ESKD) in need of chronic life‐sustaining renal replacement therapy increases substantially among older age groups (United States Renal Data System 2018). As peritoneal dialysis (PD) confers advantages for older individuals, including home‐based treatment, avoiding the need to travel to and from the dialysis unit, and fewer haemodynamic variations (Guilloteau et al 2018), the number of older adults undergoing PD is increasing, especially in developing countries. In 2016, it was reported that over 33% of patients undergoing PD in China were above the age of 60 (Wu et al 2016).…”

Section: Introductionmentioning

confidence: 99%

Family caregiver's burden and the social support for older patients undergoing peritoneal dialysis

Tao

Chow

Hai-fen

et al. 2020

Journal of Renal Care

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SUMMARY Background Most elderly people undergoing peritoneal dialysis (PD) treatment have a high incidence of frailty, cognitive impairment and emotional disturbance leading to a significant impact on families. The burden experienced by the family caregivers could affect their physical and emotion health. The objective of this study was to examine the level of burden on family caregivers of elderly adults receiving PD and to identify any contributing factors. Materials and Methods This was a cross‐sectional study employing convenience sampling. Patient–caregiver dyads were recruited from the outpatient clinic of a university hospital in China in 2019. Caregivers provided information on their perceived burden and health‐related quality of life. The elderly patients reported their functional dependence and depressive symptoms in the same interview. Linear regression analyses were used to determine the factors contributing to caregivers’ burden. Results Sixty patient–caregiver dyads were recruited. The patients had a mean age of 70.7 ± 7.4 years. The caregivers reported moderate levels of burden having ZBI score of 30.5 ± 15.9. Multivariate analyses showed that being female, perceiving one's financial status as insufficient, a low level of social support for the caregiver, depressive symptoms in the patients and disability in carrying out the instrumental activities of daily life were statistically significant predictors of caregiver burden (adjusted R2 = 0.46, p < 0.001). Conclusion Elderly adults receiving PD who experience physical dependence and depressive symptoms are a burden for caregivers. In response to this challenge, interventions designed with the goal of supporting the emotional and mental wellbeing of caregivers are warranted.

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Section: Introductionmentioning

confidence: 99%

Family caregiver's burden and the social support for older patients undergoing peritoneal dialysis

Tao

Chow

Hai-fen

et al. 2020

Journal of Renal Care

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“…A retrospective observational study in the United Kingdom 9 showed that the peritonitis rate was 1:36.7 patient-months for APD-treated patients and 1:28.8 patient-months for CAPD-treated patients, representing an odds ratio of 0.78 favoring APD. Conversely, three recent observational studies found that PD modality was unassociated with a higher likelihood of developing peritonitis 11 – 13 . Differing study populations, follow-up times, improvements in CAPD and APD connection systems, and advances in nursing care and dialysis treatment may have led to the differing results in these studies.…”

Section: Discussionmentioning

confidence: 91%

“…Peritonitis is a major cause of PD failure via structural and functional alterations of the peritoneal membrane 16 , which can lead to life-threatening events 9 , 17 . Previous reports have shown a relationship between PD modality and peritonitis, but these studies are observational 9 – 13 rather than randomized control trials 14 , 15 . Results of many studies have shown that patients on APD have a lower or similar incidence of peritonitis than do those on CAPD.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports have investigated the risk of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) versus automated peritoneal dialysis (APD) 9 – 15 . The available evidence is predominantly based on observational studies 9 – 13 but not randomized control studies 14 , 15 and is insufficient to evaluate the relationship between peritonitis risk and PD modality. The analysis of these studies is handicapped by failure to report on the connection device in the cyclers used.…”

Section: Introductionmentioning

confidence: 99%

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Relationship between initial peritoneal dialysis modality and risk of peritonitis

Kokubu¹,

Matsui²,

Uemura³

et al. 2020

Sci Rep

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Peritonitis is a critical complication of peritoneal dialysis (PD). Investigators have reported the risk of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) versus automated peritoneal dialysis (APD), but the available evidence is predominantly based on observational studies which failed to report on the connection type. Our understanding of the relationship between peritonitis risk and PD modality thus remained insufficient. We studied 285 participants who began PD treatment between 1997 and 2014 at three hospitals in Nara Prefecture in Japan. We matched 106 APD patients with 106 CAPD patients based on their propensity scores. The primary outcome was time to first episode of peritonitis within 3 years after PD commencement. In total, PD peritonitis occurred in 64 patients during the study period. Patients initiated on APD had a lower risk of peritonitis than did those initiated on CAPD in both the unadjusted and adjusted models. The hazard ratio (HR) and 95% confidence interval (CI) for the primary endpoint were 0.30 (0.17–0.53) in the fully adjusted model including connection type. In the matched cohort, APD patients had a significantly lower risk of peritonitis than did CAPD patients (log-rank: p < 0.001, HR 0.32, 95% CI 0.16–0.59). The weighting-adjusted analysis of the inverse probability of treatment yielded a similar result (HR 0.35, 95% CI 0.18–0.67). In conclusion, patients initiated on APD at PD commencement had a reduced risk of peritonitis compared with those initiated on CAPD, suggesting APD may be preferable for prevention of peritonitis among PD patients.

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“…Figure 2 was depicted to demonstrate how patients' treatment adherence has changed after switching to RM-APD. According to Figure 2, alarms received from the device decreased within months, and treatment adherence of patients increased (from 4 [3][4][5][6][7][8] to 2 [0-3], p = 0.001). Also, patient median body weight decreased from 62.7 to 61 kg within 6 months.…”

Section: Resultsmentioning

confidence: 99%

Automated Remote Monitoring for Peritoneal Dialysis and Its Impact on Blood Pressure

et al. 2020

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Introduction: Peritoneal dialysis (PD) provides a safe, home-based continuous renal replacement therapy for patients. The adherence of the patients to the prescribed dialysis fluids cannot always be monitored by physicians. Remote monitoring automated peritoneal dialysis (RM-APD) can affect patients' compliance with treatment and, thus, clinical outcomes. Objective: We aimed to evaluate the clinical outcomes of patients with a remote access program. Methods: This was an observational study. We analyzed the effect of RM-APD on treatment adherence, dialysis adequacy, and change in blood pressure control, sleep quality, and healthrelated quality of life during the 6 months of follow-up. Results: A total of 15 patients were enrolled in this study. It was found that there was a significant decrease (99 ± 19 vs. 89 ± 11 mm Hg) in mean arterial blood pressure of patients, and a considerable increase in Kt/V was observed in the sixth month after the RM-APD switch (2.11 ± 0.4 vs. 2.25 ± 0.5). A significant increase was found when comparing the 3-month and 6-month ultrafiltration amounts before RM-APD and the ultrafiltration amount within 6 months after RM-APD (800 mL [500-1,000] and 752 mL vs. 824 mL 183]). The daily antihypertensive pill need (4 [0-7] vs. 2 [0-6]) and alarms received from the device decreased (from 4 [3-8] to 2 [0-3]) at the sixth month of the switch. There was no significant change in sleep quality and health-related quality of life within 6 months. Conclusion: This study showed that treatment adherence and ultrafiltration amounts of patients increased with the use of RM-APD, as well as better blood pressure control with fewer antihypertensive drugs.

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Impact of Assisted Peritoneal Dialysis Modality on Outcomes: A Cohort Study of the French Language Peritoneal Dialysis Registry

Cited by 28 publications

References 43 publications

Family caregiver's burden and the social support for older patients undergoing peritoneal dialysis

Family caregiver's burden and the social support for older patients undergoing peritoneal dialysis

Relationship between initial peritoneal dialysis modality and risk of peritonitis

Automated Remote Monitoring for Peritoneal Dialysis and Its Impact on Blood Pressure

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