Assisted peritoneal dialysis: what is it and who does it involve?

Together with the obvious increase of elderly patients with end-stage renal disease (ESRD), utilization of peritoneal dialysis (PD) has declined since the mid-1990s in a number of countries--a decline that is particularly marked in this elderly ESRD population. A major obstacle that affects any dialysis modality in elderly patients is the greater disease burden than is seen in younger patients. However; this factor may be overcome if patients start PD with assistance provided by visiting helpers (nurses or others) or people at home, mostly family members. Assisted PD (aPD) is suitable for; but not limited to, elderly patients who are unable to perform PD for themselves at home. Important considerations of an assisted model of care include frequency of visits, type of health care, and tasks to be performed for the patient at home. Clinical experience worldwide shows that aPD offers acceptable survival for most elderly and disabled patients, with no significant difference in modality-related complications from those seen in self-performed PD. Elderly patients on aPD experience more frequent hospitalizations, with longer hospital stays. Costs of aPD vary from country to country, depending on the frequency of visits and on reimbursement policies. Most authors believe that aPD can be cost-effective when compared with in-center hemodialysis.