Results in Assisted Peritoneal Dialysis: A Ten-Year Experience.

Sara Querido,Patrícia Quadros Branco,Elisabete Costa,Sara Pereira,José Diogo Barata,Maria Augusta Gaspar

doi:10.1155/2015/712539

Abstract

Background/Aims. Peritoneal dialysis is a successful renal replacement therapy (RRT) for old and dependent patients. We evaluated the clinical outcomes of an assisted peritoneal dialysis (aPD) program developed in a Portuguese center. Methods. Retrospective study based on 200 adult incident patients admitted during ten years to a PD program. We included all 17 patients who were under aPD and analysed various parameters, including complications with the technique, hospitalizations, and patient and technique survival. Results. The global peritonitis rate was lower in helped than in nonhelped patients: 0.4 versus 0.59 episodes/patient/year. The global hospitalization rate was higher in helped than in nonhelped patients: 0.67 versus 0.45 episodes/patient/year (p = NS). Technique survival in helped patients versus nonhelped patients was 92.3%, 92.3%, 83.1%, and 72.7% versus 91.9%, 81.7%, and 72.1%, and 68.3%, at 1, 2, 3, and 4 years, respectively (p = NS), and patient survival in helped patients versus nonhelped patients was 93.3%, 93.3%, 93.3%, and 74.7% versus 95.9% 93.7%, 89%, and 82% at 1, 2, 3, and 4 years, respectively (p = NS). Conclusions. aPD offers an opportune, reliable, and effective home care alternative for patients with no other RRT options.

Highlights

In the last two decades, most developed countries have seen a continuous growth in the number of patients with endstage renal disease (ESRD) commencing renal replacement therapy (RRT)
The technique survival was defined in patients who remained on assisted peritoneal dialysis (PD) (aPD) during the observation period and kidney receptors allograft and patients who died during the aPD program due to any reason other than peritonitis or peritoneal membrane failure
We followed a cohort of 17 consecutive incident patients who were engaged in aPD from January 2004 to October 2014

Summary

Introduction

In the last two decades, most developed countries have seen a continuous growth in the number of patients with endstage renal disease (ESRD) commencing renal replacement therapy (RRT). In Portugal in 2014, almost 60% of patients starting dialysis were over the age of 65 years and only 8,73% of all incident patients started PD Despite this increase in the number of elderly and dependent patients who need RRT [3], a decline in the utilization of peritoneal dialysis (PD) has occurred in a number of countries since the mid-1990s [4]. Elderly and dependent patients benefit, specially, from PD as it would avoid travelling to dialysis centers, reduce hemodynamic instability [6], diminish the risk of central venous catheter-associated bacteremia [5], improve blood pressure control [5, 7], and diminish the bacterial translocation and myocardial stunning [8] Such a population cohort is susceptible to several physical barriers (decreased strength to lift PD bags, decreased manual dexterity, and decreased vision, mobility, and hearing) and cognitive barriers (language, noncompliance, dementia, and psychiatric conditions). APD is a dialysis modality in evolution all over Western Europe, Canada, South America, and Asia [11,12,13,14,15,16]

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