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30-04-2012 | General practice | Article

Assisted peritoneal dialysis has advantages over self-care

Abstract

Free abstract

MedWire News: People undergoing assisted peritoneal dialysis (PD) experience fewer complications than those performing PD self-care, French researchers believe.

Their analysis of registry data indicates that PD patients who receive help from nurses are less likely to be transferred for hemodialysis than patients who self-care.

"We believe that the funding of assisted PD should be evaluated and compared with the cost of in-center hemodialysis by healthcare providers," say Thierry Lobbedez (CHU Clemenceau, Caen) and co-authors in the Clinical Journal of the American Society of Nephrology.

The researchers evaluated the impact of assisted PD - whereby PD is performed at the patients' home with the help of a healthcare technician, community nurse, family member, or partner - on the risk for technique failure.

They explain: "Chronic patient burnout, fatigue, and loss of functional capacity may contribute to PD failure. Therefore, assisted PD could decrease the risk for transfer to hemodialysis."

They retrospectively analyzed data on 9822 PD patients in the French Language Peritoneal Dialysis Registry, of whom 5286 were receiving assistance. The assisted PD patients tended to be older and have greater comorbidities than self-care PD patients, Lobbedez et al note.

The researchers looked at four outcomes: transfer for hemodialysis (the primary outcome), death during PD, transplantation, and renal function recovery.

The median duration of PD was 16.49 months during which time there were a total of 7594 outcome events (2464 transfers to hemodialysis, 3495 deaths, 1489 renal transplantations, and 146 renal function recoveries).

The causes of transfer for hemodialysis were peritonitis (n=495), dialysis inadequacy (n=612), psychosocial reasons (n=268), catheter dysfunction (n=232), ultrafiltration failure (n=201), malnutrition (n=70), miscellaneous reasons related to PD (n=284), miscellaneous reasons unrelated to PD (n=297), and unknown reasons (n=5).

In analyses that adjusted for age, gender, comorbidities, prior hemodialysis, and multiple other covariates, assisted PD was associated with a significantly reduced risk for transfer to hemodialysis, at an adjusted relative hazard (RH) of 0.85 versus self-care.

The risk reduction occurred only in patients receiving nurse-assisted PD, however, at an RH of 0.87, whereas those receiving family-assisted PD had a risk for transfer similar to that of self-care patients.

Other factors that were independently associated with the risk for hemodialysis transfer included center size (RH=0.83 for centers treating >20 new patients/year versus those treating <10), prior hemodialysis (RH=1.31), failed transplantation (RH=1.63), and early peritonitis (RH=1.53).

The researchers conclude: "Assisted PD is associated with a lower risk for technique failure in a European country where assistance is covered by the national health care insurance.

"We believe that assistance should be considered as a means to maintain PD for patients who choose to be treated by PD or to continue undergoing PD despite functional impairment or who are not willing to perform PD by themselves."

By Joanna Lyford

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