Peritoneal Dialysis: A Home-Based Therapy Option with Improving Outcomes in Older As Well As Younger Patients - Abstract
Aim: To evaluate the quality, effectiveness, and sustainability of peritoneal dialysis as a home-based dialysis care option in older patients as well as younger patients after initiation of a nurse led Home before Hospital model of care.
Methods: Because peritoneal dialysis is reputedly less effective for older patients, especially those with comorbidities, clinical data (demographics, peritoneal dialysis modality, complications, reasons for technique failure / discontinuation of peritoneal dialysis and other clinical and outcome measures) was collected over 8 years until December 2019 in a
cohort of 317 patients (324 episodes of care) and compared between two age group categories (< 60 years (younger (n= 149)) and > 60 years (older (n=168)) both descriptively and analytically.
Results: Diabetes (as a diagnosis or a comorbid condition (n=134) was more common in the older group (p<.007) as was death (n=76) as an outcome (p<.001). Progression to transplantation (n=77) was more likely in the younger (p<.001) but the reasons for transfer to hemodialysis (n=59) was not different between the groups including peritonitis (n=16) or membrane failure (n=5). The technique failure rate when censored for death favored the older group (HR=0.74 (CI 95% (0.44 - 1.23)) but not significantly so (p=.246) and the death-censored technique survival rate in the older group exceeded 75% at 3 years.
Conclusion: Using a nurse-led model of care, an extremely high level of transition to a sustainable and successful home-based therapy (centered on peritoneal dialysis) can be achieved in older as well as younger patients.