The place for cycler-assisted peritoneal dialysis in geriatric patients: comparison with hemodialysis

This study was designed to assess the place for cycler assisted peritoneal dialysis (CCPD) in the treatment of the elderly. The study population included 542 hemodialysis (HD) and 160 CCPD patients, including 206 HD and 60 CCPD patients older than 60 years of age. Physical activity (evaluated by the Karnofsky scale), risk of hospitalization, risk of death, subjective evaluation of health status (Nottingham Health Profile), peritonitis rate and peritoneal transport rates were evaluated. The incidence of peritonitis and solute transport rates among elderly and younger CCPD patients were similar. Physical activity scores were consistently lower among the elderly patients without differences between HD and CCPD. No apparent differences in the subjective assessment of physical health was seen between the elderly on HD and CCPD. Sixty percent of the elderly CCPD patients required partner assistance. The relative risk of hospitalization, risk of death and risk of discontinuation of therapy were higher for the elderly patients (p<0.05), without significant differences between HD and CCPD patients. No significant differences in the transfer rate to other therapy were seen between the elderly undergoing HD and CCPD. Our results show that CCPD is a viable alternative for the treatment of the elderly uremic patients. The increased need for partners among the elderly, and CCPD's advantage of facilitating partner assistance with minimal time demands, may increase the population of aging patients treated in their own home or in nursing homes. The economic impact of cycler therapy among the elderly deserves further evaluation.