Maintenance of continuous ambulatory peritoneal dialysis in elderly patients

In Japan, peritoneal dialysis (PD) remains the principal modality of home dialysis for the elderly although PD patients accounted for only 3.3% (n = 9,728) of the overall dialysis patient population. One of the preventing factors for introduction of PD in elderly patients is the Japanese public nursing care system. Besides, difficulties in the continuation of dialysis therapy will arise because of the progression of dementia as well as the decline in muscular strength, vigor, and physical strength of patients. In spite of these difficulties, some local dialysis centers tried to maintain and manage elderly dialysis patients at home by utilizing diverse social resources, in addition to obtaining the cooperation of care givers such as family members. In our hospital, approximately 40% of patients who started dialysis therapy have selected PD. To support patients on PD, several special forms of care are prepared: utilization of visiting nurse care or home-visit nursing care services, supply of information on renal failure and education to home-care support providers and welfare service facility staff members. In addition, modulation of PD therapy such as automated PD and hemodialysis and PD in combination is also properly prepared. Lastly, the organization of a team, including physicians, nurses, social workers and dietitians, and the construction of a centralized patient information management system are important for elderly patients who need dialysis therapy.