Worldwide Experiences with Assisted Peritoneal Dialysis

2017 ◽  
Vol 37 (5) ◽  
pp. 503-508 ◽  
Author(s):  
Anna Giuliani ◽  
Akash Nayak Karopadi ◽  
Mario Prieto-Velasco ◽  
Sabrina Milan Manani ◽  
Carlo Crepaldi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Elderly Patients ◽  
Elderly Population ◽  
Age Groups ◽  
The Elderly ◽  
Clinical Results ◽  
Social Barriers ◽  
Stage Renal Disease ◽  
End Stage ◽  
Assisted Peritoneal Dialysis

End-stage renal disease (ESRD) is common in the elderly population, and renal replacement therapy (RRT) is often required. However, in this particular subgroup of patients, the choice between hemodialysis (HD) and peritoneal dialysis (PD) is often not an easy decision to make. Published literature has adequately demonstrated that PD prevalence is significantly less than HD across all patient age groups despite several advantages. We also know that elderly patients are less likely to complete a PD assessment, due to both medical and social barriers. Additionally, elderly patients are often reluctant to go ahead with PD despite being eligible PD candidates, mainly due to the fear of performing self-therapy. Recently, many new assisted PD (asPD) programs have cropped up in several countries. The main aim of these programs is to overcome barriers to PD and to promote PD utilization among elderly and non-self-sufficient patients. Although asPD has proven to be associated with good clinical results, there still remain concerns about its greater use. In this review, we will first describe an ideal asPD model and then enumerate examples of strategies and outcomes associated with successful asPD programs worldwide.

scholarly journals Complications and outcomes of urgent-start peritoneal dialysis in elderly patients with end-stage renal disease in China: a retrospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e032849
Author(s):  
Xiujuan Zang ◽  
Xiu Du ◽  
Lin Li ◽  
Changlin Mei
Keyword(s):  
Cohort Study ◽  
Peritoneal Dialysis ◽  
Elderly Patients ◽  
Renal Disease ◽  
Retrospective Cohort Study ◽  
End Stage Renal Disease ◽  
Retrospective Cohort ◽  
Dialysis Method ◽  
Stage Renal Disease ◽  
End Stage

ObjectivesTo investigate the complications and survival of elderly patients with end-stage renal disease (ESRD) who received urgent-start peritoneal dialysis (USPD) or urgent-start haemodialysis (USHD), and to explore the value of peritoneal dialysis (PD) as the emergent dialysis method for elderly patients with ESRD.DesignRetrospective cohort study.SettingTwo tertiary care hospitals in Shanghai, China.ParticipantsChinese patients (n=542) >65 years of age with estimated glomerular filtration rate ≤15 mL/min/m2who received urgent-start dialysis between 1 January 2005 and 31 December 2015, and with at least 3 months of treatment. Patients who converted to other dialysis methods, regardless of the initial dialysis method, were excluded, as well as those with comorbidities that could significantly affect their dialysis outcomes.Primary and secondary outcome measuresDialysis-related complications and survival were compared. Patients were followed until death, stopped PD, transfer to other dialysis centres, loss to follow-up or 31 December 2016.ResultsThere were 309 patients in the USPD group and 233 in the USHD group. The rate of dialysis-related complications within 30 days after catheter implantation was significantly lower in the USPD group compared with the USHD group (4.5% vs 10.7%, p=0.031). The 6-month and 1, 2 and 3-year survival rates were 95.3%, 91.4%, 86.6% and 64.8% in the USPD group, and 92.2%, 85.7%, 70.2% and 57.8% in the USHD group, respectively (p=0.023). The multivariable Cox regression analysis showed that USHD (HR=2.220, 95% CI 1.298 to 3.790; p=0.004), age (HR=1.025, 95% CI 1.013 to 1.043, p<0.001) and hypokalaemia (HR=0.678, 95% CI 0.487 to 0.970; p=0.032) were independently associated with death.ConclusionsUSPD was associated with slightly better survival compared with USHD. USPD was associated with fewer complications and better survival than USHD in elderly patients with ESRD.

scholarly journals Long-term drug use and polypharmacy among the elderly population in the Republic of Srpska, Bosnia and Herzegovina

2016 ◽  
Vol 73 (5) ◽  
pp. 435-441
Author(s):  
Vanda Markovic-Pekovic ◽  
Ranko Skrbic
Keyword(s):  
Drug Use ◽  
Elderly Patients ◽  
Bosnia And Herzegovina ◽  
Elderly Population ◽  
Age Groups ◽  
The Elderly ◽  
Insurance Fund ◽  
The Republic ◽  
Multiple Drugs

Background/Aim. Prescription of drugs is a fundamental care component of the elderly. Elderly patients often take multiple drugs, and it is known that polypharmacy may lead to drug interactions and adverse events. The aim of this study was to analyze the long-term drug use and the prevalence of polypharmacy among the elderly population in the Republic of Srpska, Bosnia and Herzegovina. Methods. A retrospective study of outpatient drug use in 2005 and 2010 was conducted, analyzing prescriptions for patients aged ? 65 years reimbursed by the Health Insurance Fund. The study population was stratified by gender and age. Long-term drug use was defined as continuous drug dispensing for a whole year or at least two thirds of the year. Polypharmacy was defined as the use of 5 or more different reimbursed drugs. Results. Of all insured people aged ? 65 years, long-term drug use was identified in 10% (2005) and in 19% (2010), of whom 62% were women. Two to four different drugs were used by almost 49% (2005) and 54% (2010) of the elderly patients. The polypharmacy prevalence increased from 1.4% (2005) to 3.6% (2010); it increased in all the age groups of both genders. The largest increase was observed in the age group 65-74 years. Polypharmacy prevalence increase was higher in women. The most commonly used drugs were those for to treatment of cardiovascular diseases, in particular drugs for hypertension and cardiac treatment. Conclusion. The study findings point out to the increase of elderly population with a long-term drug use. Over a half of elderly patients use 2-4 different drugs on the long-term basis. The polypharmacy prevalence was low. It increased in the period of 5 years in both genders. The increase was more prominent in women of all the age groups. The use of multiple drugs and polypharmacy increased with ageing.

Nghiên cứu tình trạng suy yếu trên bệnh nhân cao tuổi suy thận mạn giai đoạn cuối lọc máu chu kỳ

2021 ◽  
Author(s):  
Xuan Thu Pham Thi
Keyword(s):  
Elderly Patients ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
The Elderly ◽  
Maintenance Hemodialysis ◽  
Geriatric Syndrome ◽  
Clinical Frailty Scale ◽  
Cross Sectional ◽  
Stage Renal Disease ◽  
End Stage

Giới thiệu: Suy yếu là một hội chứng lão hóa thường gặp, làm gia tăng các kết cục lâm sàng bất lợi ở người cao tuổi. Suy yếu đặc biệt chiếm tỷ lệ rất cao > 60% ở bệnh nhân cao tuổi suy thận mạn giai đoạn cuối lọc máu chu kỳ. Tuy nhiên, các nghiên cứu tại Việt Nam hiện nay chưa khảo sát trên đối tượng đặc biệt này. Mục tiêu: Xác định tỷ lệ suy yếu theo thang điểm suy yếu lâm sàng và các yếu tố liên quan trên bệnh nhân cao tuổi suy thận mạn giai đoạn cuối lọc máu chu kỳ. Đối tượng và phương pháp nghiên cứu: Cắt ngang mô tả và theo dõi dọc trên 175 bệnh nhân cao tuổi suy thận mạn giai đoạn cuối lọc máu chu kỳ ngoại trú tại Khoa Thận - Thận nhân tạo Bệnh viện Trưng Vương và Bệnh viện Thống Nhất từ 11/2020 đến 06/2021. Kết quả: Tỷ lệ suy yếu trên bệnh nhân cao tuổi suy thận mạn giai đoạn cuối lọc máu chu kỳ là 69,7%. Sau phân tích hồi quy đa biến, có mối liên quan giữa suy yếu và tuổi (PR = 1,23; KTC 95%: 1,12 - 1,35; p < 0,001); suy dinh dưỡng (SDD) (PR = 2,17; KTC 95%: 1,61 - 2,92; p < 0,001) và nguy cơ SDD theo thang điểm MNA - SF (PR = 1,47; KTC 95%: 1,27 - 1,71; p < 0,001); nguy cơ té ngã (PR = 1,63; KTC 95%: 1,28 - 2,07; p < 0,001). Kết luận: Suy yếu chiếm tỷ lệ rất cao ở bệnh nhân cao tuổi suy thận mạn giai đoạn cuối lọc máu chu kỳ và có mối liên quan độc lập với tuổi, tình trạng suy dinh dưỡng và té ngã. Từ khóa: Suy yếu, người cao tuổi, suy thận mạn giai đoạn cuối, lọc máu chu kỳ. ABSTRACT FRAILTY IN ELDERLY PATIENTS WITH END - STAGE KIDNEY DISEASE UNDERGOING HEMODIALYSIS Background: Frailty is a geriatric syndrome which is associated with an increased incidence of adverse clinical outcomes in the elderly. Frailty is particularly high > 60% in elderly patients with end - stage renal disease undergoing hemodialysis. However, research on frailty for this special populationhas not been done in Vietnam. Objective: To determine the prevalence of frailty according to the Canadian Clinical Frailty Scale (CFS) and investigate factors related to frailty in elderly patients with end - stage renal diseaseunder hemodialysis. Methods: Cross - sectional study and longitudinal follow - up, performed on 175 elderly patients with end - stage renal disease on maintenance hemodialysis at the Department of Nephrology at Trung Vuong Hospital and Thong Nhat Hospitalfrom November 2020 to June 2021. Results: The prevalence of frailty in elderly patients with end - stage renal disease on maintenance hemodialysis was 69.7%. After multivariate regression analysis, there was a relationship between frailty and age (PR = 1.23; 95% CI: 1.12 - 1.35; p < 0.001); malnutrition (PR = 2.17; 95% CI: 1.61 - 2.92; p < 0.001) and risk of malnutrition according to the MNA-SF scale (PR = 1.47; 95% CI: 1.27 - 1.71; p < 0.001); risk of falling (PR = 1.63; 95% CI: 1.28 - 2.07; p < 0.001). Conclusion: The prevalence of frailty was very high in elderly patients with end-stage renal disease on maintenance hemodialysis and frailty was independently associated with age, malnutrition, and falls. Keywords: Frailty, clinical frailty scale, elderly people, end - stage renal disease, hemodialysis

scholarly journals Selective Infracolic Omentecomy and Fixation Reduces Complications after Laparoscopic Assisted Peritoneal Dialysis Catheter Placement

2018 ◽  
Vol I (1) ◽  
pp. 6-11
Author(s):  
Andries Ryckx
Keyword(s):  
Peritoneal Dialysis ◽  
Catheter Placement ◽  
Peritoneal Dialysis Catheter ◽  
Catheter Survival ◽  
Stage Renal Disease ◽  
End Stage ◽  
Laparoscopic Assisted ◽  
Infracolic Omentectomy ◽  
Assisted Peritoneal Dialysis

Peritoneal dialysis (PD) as a treatment for patients with end-stage renal disease (ESRD) provides a competitive alternative to hemodialysis (HD). Long-term catheter survival remains challenging and techniques are not standardized. Advanced laparoscopic placement with fixation and omentectomy might increase catheter survival. The goal of our study was to evaluate if selective infracolic omentectomy and fixation reduced complications after CAPD catheter placement.

scholarly journals Assisted Peritoneal Dialysis for Older People with End-Stage Renal Disease: The French and Danish Experience

2015 ◽  
Vol 35 (6) ◽  
pp. 663-666 ◽  
Author(s):  
Clémence Béchade ◽  
Thierry Lobbedez ◽  
Per Ivarsen ◽  
Johan V. Povlsen
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Older People ◽  
End Stage Renal Disease ◽  
Advanced Age ◽  
Dialysis Unit ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Cost ◽  
Assisted Peritoneal Dialysis

Older people are the largest and fastest growing group of patients with end-stage renal disease (ESRD), and, due to advanced age and a heavy burden of comorbidities, they are usually not candidates for renal transplantation or home-based dialysis treatment. Some of the barriers for home treatment are non-modifiable, but the majority of physical disabilities and psychosocial problems can be overcome provided that assistance is offered to the patients at home. In the present review, we describe the programs for assisted peritoneal dialysis (PD) in France and Denmark, respectively. In both nations, assisted PD is totally publicly funded, and the cost of assisted PD is comparable to the cost of in-center HD. Assisted continuous ambulatory PD (aCAPD) is the preferred modality in France whereas assisted automated PD (aAPD) is the preferred modality in Denmark. Assistants are professional nurses or healthcare technicians briefly educated by expert PD nurses from the dialysis unit. The establishment of a program for assisted PD may increase the number of patients actually treated with PD and may reduce the risk of PD technique failure and prolong PD duration. Compared with autonomous PD patients, patients on assisted PD may have shorter patient survival and peritonitis-free survival indicating that, besides advanced age and the burden of comorbidities, dependency on help may be an independent risk factor for poorer outcome. Assisted PD is an evolving dialysis modality, and may in the future prove to be a feasible complementary alternative to in-center hemodialysis (HD) for the growing group of dependent older patients with ESRD.

Chronic Peritoneal Dialysis in the Elderly: A Review

2000 ◽  
Vol 20 (3) ◽  
pp. 276-283 ◽  
Author(s):  
Nada Dimkovic ◽  
Dimitrios G. Oreopoulos
Keyword(s):  
Quality Of Life ◽  
Peritoneal Dialysis ◽  
Elderly Patients ◽  
Renal Disease ◽  
Family Support ◽  
End Stage Renal Disease ◽  
Good Control ◽  
Stage Renal Disease ◽  
End Stage

During the past few decades, the pattern of end-stage renal disease has changed significantly with the emerging predominance of elderly patients. Because this heterogeneous population is characterized by a physiological decline in function of all organs, the nephrologist must contemplate the special needs of individual patients when they develop end-stage renal disease. Before the initiation of dialysis, these patients must be given detailed information to help them select the particular mode that will maximize their quality of life. According to available data, peritoneal dialysis offers some advantages for elderly patients, such as hemodynamic stability, steady-state metabolic control, good control of hypertension, independence from hospital, and avoidance of repeated vascular access. Early referral promotes the establishment of peritoneal access and minimizes the consequences of uremia, subsequent morbidity, and frequent hospitalization. Elderly patients are compliant and highly motivated to cooperate with their treatment. They have no higher modality-related complications than younger patients and their quality of life is satisfactory. Although most have comorbid conditions that interfere with self-performance of dialysis, such as impaired vision and reduced physical and mental activity, they can perform peritoneal dialysis successfully if they have a high level of family support. Patients who do not have family support may have successful peritoneal dialysis if they have access to a network of medical and social support, that is, private home nurses, rehabilitation and chronic care dialysis units, or nursing homes.

Experiences of Living with Assisted Peritoneal Dialysis – A Qualitative Study

2017 ◽  
Vol 37 (6) ◽  
pp. 605-612 ◽  
Author(s):  
Ingrid Petersson ◽  
Annette Lennerling
Keyword(s):  
Peritoneal Dialysis ◽  
Home Based ◽  
Centered Care ◽  
Disabled Patients ◽  
Uncertain Future ◽  
Stage Renal Disease ◽  
End Stage ◽  
Depth Interviews ◽  
Assisted Peritoneal Dialysis

BackgroundPeople's experiences of living with assisted peritoneal dialysis (aPD) have not been studied previously. Assisted PD is successfully used as renal replacement therapy for elderly and disabled patients with end-stage renal disease. To be treated with aPD implies being dependent on lifelong treatment at home. The aim of this study was to explore adults’ experiences of living with aPD.MethodsIn-depth interviews were conducted with 10 participants with aPD, median age 82.5 years. The text was analyzed using a phenomenological-hermeneutical method.ResultsThe participants experienced limitations and an uncertain future, but through different strategies and participation in healthcare, they could still enjoy what was important in life for them. The analysis of the text resulted in 4 main themes; 1) Facing new demands, 2) Managing daily life, 3) Partnership in care, and 4) Experiencing a meaningful life, leading to the comprehensive understanding: ‘Striving for maintaining wellbeing’.ConclusionThe participants expressed that they experienced a good quality of life despite being physically frail, severely ill, and in need of home-based lifesaving treatment. The findings suggest that aPD should be available everywhere where PD is offered. Integrating the model of person-centered care may greatly improve the care for persons living with aPD.

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