Assisted Peritoneal Dialysis Implementation: A Pilot Program From a Large Dialysis Unit in Quebec.

Area of Science:

• Nephrology
• Geriatric Medicine
• Public Health

Background:

• Increasing prevalence of kidney failure in older adults presents challenges for dialysis initiation.
• Assisted peritoneal dialysis (PD), involving healthcare worker support, can enable PD for frail patients.
• This study piloted the first assisted PD program in Quebec, Canada.

Purpose of the Study:

• To assess the feasibility of implementing an assisted PD program.
• To evaluate the characteristics and outcomes of PD patients before and after assisted PD availability.
• To compare outcomes between assisted PD and independent PD cohorts.

Main Methods:

• Observational retrospective cohort study of adult PD patients (2015-2020).
• Comparison of PD incidence, characteristics, and outcomes between pre-assisted (2015-2017) and post-assisted (2018-2020) eras.
• Analysis of peritonitis rates, hospitalizations, transfers to hemodialysis (HD), and mortality.

Main Results:

• PD incidence increased in the post-assisted era, but the difference was not statistically significant.
• First-year peritonitis rates were similar between the pre- and post-assisted PD eras.
• Patients receiving assisted PD were older; no differences in crude peritonitis or hospitalization rates were observed compared to independent PD patients.
• The adjusted hazard of transfer to HD or death was higher in the post-assisted PD era (HR: 2.77).

Conclusions:

• Implementation of an assisted PD program is feasible.
• Assisted PD offers favorable outcomes regarding peritonitis rates in the first year.
• Further research is needed to understand the increased risk of transfer to HD or death observed in the post-assisted PD era.