Assisted peritoneal dialysis: what is it and who does it involve?

Area of Science:

• Nephrology
• Geriatrics
• Public Health

Background:

• Utilization of peritoneal dialysis (PD) has declined, especially among elderly patients with end-stage renal disease (ESRD).
• Elderly patients often have a higher disease burden, posing challenges for dialysis modality selection.
• Assisted PD (aPD) emerges as a potential solution for this demographic.

Purpose of the Study:

• To evaluate the suitability and outcomes of assisted peritoneal dialysis (aPD) for elderly and disabled patients.
• To identify key considerations for implementing an assisted PD model of care.
• To compare aPD with other dialysis modalities, including in-center hemodialysis.

Main Methods:

• Review of clinical experience and outcomes of assisted PD (aPD) globally.
• Analysis of factors influencing aPD, such as visit frequency, healthcare type, and home-based tasks.
• Comparison of survival rates, complications, hospitalizations, and costs between aPD and self-performed PD.

Main Results:

• Assisted PD (aPD) provides acceptable survival for most elderly and disabled patients.
• Modality-related complications in aPD are not significantly different from self-performed PD.
• Elderly patients on aPD experience more frequent and longer hospitalizations.
• Cost-effectiveness of aPD compared to in-center hemodialysis is generally considered favorable.

Conclusions:

• Assisted PD (aPD) is a suitable dialysis option for elderly and disabled patients unable to perform PD independently.
• While hospitalizations may increase, aPD offers comparable safety and survival to self-performed PD.
• aPD can be a cost-effective alternative to in-center hemodialysis for specific patient populations.