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Assisted PD throughout Europe: advantages, inequities, and solution proposals.

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Assisted peritoneal dialysis (APD) offers significant benefits as a first-line kidney replacement therapy, especially for fragile patients. This approach requires tailored strategies and active nephrologist involvement to overcome barriers and expand its use across Europe.

Keywords:
Assisted Peritoneal DialysisCommunity careEquityFrailtyQuality of life

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Area of Science:

  • Nephrology
  • Renal Replacement Therapy
  • Dialysis Techniques

Background:

  • Peritoneal dialysis (PD) is a beneficial kidney replacement therapy, particularly for fragile patients.
  • Assisted PD evolved from family care to institutional programs due to self-care limitations.
  • Varied adoption of assisted PD exists across European countries, with some facing volunteer dependency.

Purpose of the Study:

  • To share diverse approaches to assisted PD, including challenges and solutions.
  • To guide PD units in developing and offering assisted PD programs.
  • To summarize real-life applications of assisted PD from 13 European countries.

Main Methods:

  • Integration of real-life assisted PD applications by leading nephrologists.
  • Highlighting barriers, lessons learned, and practical solutions for assisted PD.
  • Summarizing different approaches and their difficulties.

Main Results:

  • Assisted PD offers flexible prescriptions, not limited to continuous ambulatory PD or cycler use.
  • Tailoring PD prescriptions to residual kidney function improves technique survival.
  • Assisted PD can be a transitional phase towards patient or caregiver autonomy.

Conclusions:

  • Assisted PD is a valid and expandable kidney replacement therapy.
  • Nephrologist involvement is crucial for establishing assisted PD models in countries lacking them.
  • Diverse solutions exist, including private agencies and nursing home training programs.