Assisted peritoneal dialysis. Experience in a French renal department

Background. The French healthcare system offers the possibility of increasing the use of peritoneal. dialysis (PD) by involving in patient care nurses who work in the private system. Objective: This study was conducted to evaluate the impact of a private home-nurse network on one dialysis program. Methods: This was a retrospective study of 239 dialysis patients who started dialysis in our center between 1 January 1998 and 31 December 2003. Results: Of these 239 patients, 142 were treated with hemodialysis and 97 with PD during the study period. Among the PD patients, 3 6 of 97 were treated with assisted PD and 61 of 97 with self-care PD. Assisted-PD patients were older (74 10 vs 52 18 years, p < 0.001) and presented more comorbidity (Chartson Comorbidity Index 7 +/- 2.5 vs 4.3 +/- 2.4, p < 0.05) compared with self-care patients. Continuous ambulatory PD was the modality of choice in the assisted group (32/36). Assisted patients were frequently hospitalized (31/36); actuarial survival free of hospitalization at 6 months was 46%. Patients with nurse assistance had a high risk of peritonitis (actuarial survival free of peritonitis: 52% at 1 year). Technique survival was 85% at 6 months and 58% at 1 year. Actuarial patient survival was 90% at 6 months and 83% at 1 year. Conclusion: Assisted PD enables increased use of PD in incident dialysis patients. However, in view of the comorbidities of the assisted-PD patients, the need for frequent hospitalization has to be taken into account in such a program.