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. 2023 Dec;36(9):2549-2557.
doi: 10.1007/s40620-023-01765-y. Epub 2023 Oct 19.

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

Anabela Malho Guedes  1 , Sally Punzalan  2 , Edwina A Brown  2 , Agneta Ekstrand  3 , Maurizio Gallieni  4   5 , Maite Rivera Gorrín  6 , Helga Gudmundsdottir  7 , Marco Heidempergher  5 , Benno Kitsche  8   9 , Thierry Lobbedez  10 , Ulrika Hahn Lundström  11 , Kate McCarthy  12 , George J Mellotte  13 , Olivier Moranne  14 , Dimitrios Petras  15 , Johan V Povlsen  16 , Martin Wiesholzer  17
Affiliations

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

Anabela Malho Guedes et al. J Nephrol. 2023 Dec.

Abstract

Background: Peritoneal dialysis provides several benefits for patients and should be offered as first line kidney replacement therapy, particularly for fragile patients. Limitation to self-care drove assisted peritoneal dialysis to evolve from family-based care to institutional programs, with specialized care givers. Some European countries have mastered this, while others are still bound by the availability of a volunteer to become responsible for treatment.

Methods: A group of leading nephrologists from 13 European countries integrated real-life application of such therapy, highlighting barriers, lessons learned and practical solutions. The objective of this work is to share and summarize several different approaches, with their intrinsic difficulties and solutions, which might helpperitoneal dialysis units to develop and offer assisted peritoneal dialysis.

Results: Assisted peritoneal dialysis does not mean 4 continuous ambulatory peritoneal dialysis exchanges, 7 days/week, nor does it exclude cycler. Many different prescriptions might work for our patients. Tailoring PD prescription to residual kidney function, thereby maintaining small solute clearance, reduces dialysis burden and is associated with higher technique survival. Assisted peritoneal dialysis does not mean assistance will be needed permanently, it can be a transitional stage towards individual or caregiver autonomy. Private care agencies can be used to provide assistance; other options may involve implementing PD training programs for the staff of nursing homes or convalescence units. Social partners may be interested in participating in smaller initiatives or for limited time periods.

Conclusion: Assisted peritoneal dialysis is a valid technique, which should be expanded. In countries without structural models of assisted peritoneal dialysis, active involvement by the nephrologist is needed in order for it to become a reality.

Keywords: Assisted Peritoneal Dialysis; Community care; Equity; Frailty; Quality of life.

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Conflict of interest statement

AMG.: Baxter Healthcare – speaker fees. EAB.: Baxter Healthcare—advisory board and speaker fees; LiberDi, AWAK—advisory boards; Vifor–speaker fees. GJM Baxter Healthcare—speaker fees. MW Baxter Healthcare—advisory board and speaker fees; Fresenius Medical Care—speaker fees. BK speaker fees: Baxter and Fresenius Medical Care. UHL speaker and consultancy engagements for Baxter Healthcare. AE Advisory Board Boehringer Ingelheim, AstraZeneca. The results presented in this paper have not been published previously in whole or in part.

References

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