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Perit Dial Int 29(2): 238-239
2009
© 2009 International Society for Peritoneal Dialysis
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CORRESPONDENCE

CAPD Assisted by Family Member — a Single-Center Experience

N. Dimkovic1, Z. Majster1, Z. Davidovic1 and S. Dimkovic2,*

Clinical Department for Renal Diseases1 Clinical Department for Cardiology2 Zvezdara University Medical Center Belgrade, Serbia

* e-mail: dim{at}eunet.yu

Editor:

Since the first publication pertaining to assisted peritoneal dialysis (PD) (1), it has become obvious that this modification to PD may allow successful treatment of most physically disabled elderly patients. Here we report continuous ambulatory PD (CAPD) patients that were treated for more than 6 months between 2005 and 2008 at our unit. Forty patients (74%) were on self-care CAPD and 14 (26%) were on assisted CAPD due to physical disability and/or blindness. Since home-care nurses are not covered by our national healthcare system, assistance was provided by a family member (wife, husband, offspring).

Patients in the assisted group were older, had a higher comorbidity index, and more of them were diabetic and malnourished compared to the self-care group. There were no differences in early complications of PD between the two groups (bleeding, leaking, and drainage problems) (Table 1). In our group of patients, peritonitis was less frequent (1/24.8 vs 1/17.6 patient-months) and exit-site infection was more frequent in the assisted than in the self-care group. One-year survival was 78% for patients in the assisted-care group and 89% and for patients in the self-care group (Figure 1). We believe that home visits by a nurse from the training center may contribute to improved care, as described by Verger et al. (2). It is notable that patients from both groups had prolonged hospitalizations, as was also described by Lobbedez et al. (3). This is probably one of the most important stumbling blocks in assisted PD.


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  		TABLE 1 Patient Data

 

Figure 1
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  		Figure 1 — Survival of patients on self-care CAPD (heavy line) and assisted CAPD (light line). CAPD = continuous ambulatory peritoneal dialysis.

 

Reasonable peritonitis and survival rates justify assistance by a family member in most disabled elderly diabetic patients whenever a homecare nurse is not provided by a national health fund.

DISCLOSURE

The author declares no financial support.

REFERENCES

  1. Faller B, Bénévent D. Continuous ambulatory peritoneal dialysis in patients over 75 years. Nephrologie 1990;11 : 325-9.[Medline]
  2. Verger C, Duman M, Durand PY, Veniez G, Fabre E, Ryckelynck JP. Influence of autonomy and type of home assistance on the prevention of peritonitis in assisted automated peritoneal dialysis patients. An analysis of data from the French Language Peritoneal Dialysis Registry. Nephrol Dial Transplant 2007; 22:1218 -23.[Abstract/Free Full Text]
  3. Lobbedez T, Moldovan R, Lecame M, de Lignu BH, Haggan WE, Ryckelynck JP. Assisted peritoneal dialysis. Experience in a French renal department. Perit Dial Int 2006;26 : 671-6.[Abstract/Free Full Text]




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