Feasibility of in-center staff-assisted cycler dialysis

Many debilitated elderly patients are not currently considered for peritoneal dialysis because they cannot perform the procedure themselves and they lack adequate back-up support in the family or extended care facility. They often tolerate hemodialysis poorly, and may exhaust their vascular access sites. We have provided intermittent in-center staff-assisted cycler dialysis to two debilitated elderly patients for a total of 12 patient months. Initial peritoneal equilibration tests indicated high solute transport rates in both patients, and led us to evolve a regimen based on frequent cycles. We use a 4 days a week regimen, cycling 12-14 liters during a 7.5 hour period each day. The patients tolerated the treatment well, with improved control of fluid balance and maintenance or improvement in appetite compared to baseline periods of CAPD. Mean pre-treatment BUN is 87 mg/dl. This is 29% higher than during CAPD, and has been stable. The requirement for additional nursing care has been variable but not disruptive of other activities once we established a dedicated space and routine. Current cycler technology permits consideration of in-center cycling as a practical alternative for many patients previously excluded from peritoneal dialysis.