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Assisted peritoneal dialysis (asPD): age is not the key

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Abstract

Background

Peritoneal dialysis (PD) has multiple advantages over other dialysis modalities. As a home-based therapy, it allows patients to keep their autonomy, avoid frequent hospital visits and carry on with their usual lifestyle. However, as a self-care therapy, dependency has been traditionally considered a contraindication. However, assistance to perform PD (asPD) can be provided regardless of the patient’s age and the duration of such help. This paper is aimed at reporting on assisted PD use in a Spanish Center, and is the first report on asPD from this country.

Methods

We retrospectively reviewed the electronic medical records of all patients consecutively treated with PD between May 1997 and December 2020 in our PD Unit. Assisted PD was defined as PD treatment requiring the help of another person. On the basis of the duration of dependency, we divided our cohort into: Group 1: Patients totally dependent at the start of PD treatment; Group 2: self-care patients that developed total dependency during follow up; Group 3: patients who needed short-term PD assistance. Group 4, consisting of 175 self-care PD, served as the control group.

Results

Seventy-three percent of patients who required asPD did so during their follow up, showing that an important proportion of patients may require some help even if they were autonomous at the beginning of PD. Even for short time periods, asPD should be an option, as up to 44% of autonomous PD patients became dependent for different reasons over time. Spouses were the most frequent caregivers and absence or loss of caregiver was a main reason for switching to hemodialysis. Fourteen percent of the patients received asPD as palliative care, with clinical symptoms and perceived well-being as the main treatment goals, with adequate results. The need for support and the quality of life were periodically discussed by patients, family members and hospital staff.

Conclusion

Assisted PD is a safe option for dependent patients, young or elderly, and may result less expensive for our healthcare system, even when caregivers receive a financial incentive.

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Acknowledgements

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Authors and Affiliations

  1. Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Ctra Colmenar Viejo km 9.1, 28034, Madrid, Spain

    R. Haridian Sosa Barrios, Víctor Burguera Vion, Milagros Fernández Lucas & Maite E. Rivera Gorrín

  2. Universidad de Alcalá de Henares, UAH, Madrid, Spain

    Milagros Fernández Lucas & Maite E. Rivera Gorrín

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  1. R. Haridian Sosa Barrios
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  2. Víctor Burguera Vion
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  3. Milagros Fernández Lucas
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  4. Maite E. Rivera Gorrín
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Correspondence to R. Haridian Sosa Barrios.

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We have read and understood the journal policy on disclosing conflicts of interest and declare that we have none. None of the authors have any financial interests.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board at which the studies were conducted (IRB approval number 047/22) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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As data were retrospectively collected and derived from routine clinical practice, further consent was waived.

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The data underlying this article will be shared on reasonable request to the corresponding author.

Author contributions

All authors read and approved the final version of the manuscript. RHSB analysis and interpretation of data, drafting and revising the article. VBV analysis of data, revising the article. MFL revising the article. MERG Conception, design, interpretation of data, providing intellectual content of critical importance to the work described. Final approval of the version to be published.

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Sosa Barrios, R.H., Burguera Vion, V., Fernández Lucas, M. et al. Assisted peritoneal dialysis (asPD): age is not the key. J Nephrol 35, 2451–2457 (2022). https://doi.org/10.1007/s40620-022-01420-y

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