Assisted peritoneal dialysis

Abstract

Elderly patients are the largest and fastest growing group of patients with chronic kidney disease maintained on dialysis in the world. Because of advanced age and a heavy burden of comorbidities, the elderly are usually not candidates for kidney transplantation and are less likely to be offered peritoneal dialysis (PD). There is, however, growing evidence that the use of community nurses to assist with PD and the introduction of programs for assisted peritoneal dialysis (aPD) targeting these frail, elderly patients may enable more elderly patients to have their PD treatment at home. Suitable candidates for aPD are incident end-stage kidney disease patients preferring PD but unable to perform their own treatment because of comorbidities, physical disabilities, or psychosocial problems; prevalent, previous autonomous PD patients who have lost their independence because of advanced age or an increased burden of comorbidities; or prevalent hemodialysis (HD) patients switched from HD to aPD because of their own preference, failure of vascular access for HD, or an inability to tolerate HD. We believe that aPD in the future will prove to be a safe and feasible complementary alternative to in-center HD for the growing group of frail, elderly patients with end-stage kidney disease.