Abstract
Assisted PD is used as an alternative option for the growing group of frail, older ESKD patients unable to perform their own PD. This study was undertaken to investigate the outcomes of assisted PD in older patients by comparing assisted PD patients with self-care PD patients. This study included all patients aged 70 and above who started on PD in our hospital from 2009 to 2018. Patients were followed up until death, PD cessation or to the end of the study (December 31, 2019). Risk factors associated with mortality, peritonitis and technique failure were evaluated using both cause-specific hazards and subdistribution hazards models. 180 patients were enrolled, including 106 (58.9%) males with a median age of 77.5 (77.2–81.2) years. Among the 180 patients, 62 patients (34.4%) were assisted. Patients on assisted PD group were older, more likely to be female, more prevalent in DM and CVD, with a higher Charlson score than patients undergoing self-care PD (P all < 0.05). In the multivariable analysis, assisted patients had a comparable patient survival and peritonitis-free survival compared to self-care PD patients either in the Cox or in the FG models. According to a Cox model, the use of assisted PD was associated with a lower risk of technique failure (cs-HR 0.20, 95% CI 0.04–0.76), but the association lost its statistical significance in the Fine and Gray model. Our results suggest that assisted PD could be a safe and effective KRT modality for older ESKD patients who need assistance.
Highlights
Assisted PD is used as an alternative option for the growing group of frail, older end-stage kidney disease (ESKD) patients unable to perform their own PD
Patients in the assisted PD group were older (80.7 (76.9–84.0) vs 75.6 (72.5–79.2) years, P < 0.001), less likely to be male (48.4% vs 64.4%, P < 0.05), more prevalent in diabetics (48.4% vs 33.1%, P < 0.05) and cardiovascular disease (CVD) (46.8% vs 29.7%, P < 0.05), with a higher Charlson score (7.0 (6.0–8.0) vs 6.0 (5.0–7.0), P < 0.001) than those in the self-care PD group, and other demographic and laboratory data were similar between the two groups
The present study compared the outcomes between assisted PD patients and self-care PD patients aged 70 and above to investigate the safety and effectiveness of assisted PD in older patients
Summary
Assisted PD is used as an alternative option for the growing group of frail, older ESKD patients unable to perform their own PD. This study was undertaken to investigate the outcomes of assisted PD in older patients by comparing assisted PD patients with self-care PD patients. As a feasible option for patients who cannot perform their own PD exchanges, assisted PD have been developed in many countries with the aim of overcoming barriers in older and non-self-sufficient patients, and some studies suggested that the use of assisted PD could increase the utilization of PD among older patients[12,13,14]. We conducted the present study to investigate the outcomes of assisted PD in ageing patients, by comparing patients undergoing assisted PD with those on self-care PD in a cohort of older patients
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