Lincolnshire Knowledge and Resource Service

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1 Lincolnshire Knowledge and Resource Service This search summary contains the results of a literature search undertaken by the Lincolnshire Knowledge and Resource Service librarians in April All of the literature searches we complete are tailored to the specific needs of the individual requester. If you would like this search re-run with a different focus, or updated to accommodate papers published since the search was completed, please let us know. We hope that you find the information useful. If you would like the full text of any of the abstracts listed, please let us know. Alison Price Janet Badcock alison.price@lpct.nhs.uk janet.badcock@lpct.nhs.uk Librarians, Lincolnshire Knowledge and Resource Service NHS Lincolnshire Beech House, Waterside South Lincoln LN5 7JH

2 Lincolnshire Knowledge and Resource Service Please find below the results of your literature search request. If you would like the full text of any of the abstracts included, or would like a further search completed on this topic, please let us know. A feedback form is included with these search results. We would be very grateful if you had the time to complete it for us, so that we can monitor satisfaction with the service we provide. Thank you! Disclaimer Every effort has been made to ensure that this information is accurate, up-to-date, and complete. However it is possible that it is not representative of the whole body of evidence available. No responsibility can be accepted for any action taken on the basis of this information. It is the responsibility of the requester to determine the accuracy, validity and interpretation of the search results. All links from this resource are provided for information only. A link does not imply endorsement of that site and the Lincolnshire Knowledge and Resource Service does not accept responsibility for the information displayed there, or for the wording, content and accuracy of the information supplied which has been extracted in good faith from reputable sources. Lincolnshire Knowledge & Resource Service Beech House, Witham Park, Waterside South, Lincoln LN5 7JH Literature Search Results Search request date: 20 th April 2012 Search completion date: 26 th April 2012 Search completed by: Alison Price Enquiry Details Assisted Automated Peritoneal Dialysis We are investigating the about this particular type of dialysis. We are looking at the published evidence and guidelines for using this type of dialysis. Comment There are few published papers specifically referring to assisted APD. NICE Guidance does however recommend the treatment and cites one study as evidence. A Cochrane Review has been published - Rabindranath KS, Adams J, Ali TZ, MacLeod AM, Vale L, Cody JD, Wallace SA, Daly C. Continuous ambulatory peritoneal dialysis versus automated peritoneal dialysis for end-stage renal disease. Cochrane Database of Systematic Reviews 2007, Issue 2 - but this makes no reference to assisted APD. The link below is given for information only.

3 Opening Internet Links The links to internet sites in this document are live and can be opened by holding down the CTRL key on your keyboard while clicking on the web address with your mouse Full Text Papers Links are given to full text resources where available. For some of the papers, you will need a free NHS Athens Account. If you do not have an account you can register by following the steps at: You can then access the papers by simply entering your username and password. If you do not have easy access to the internet to gain access, please let us know and we can download the papers for you. Guidance on Searching within Online Documents Links are provided to the full text of each of these documents. Relevant extracts have been copied and pasted into these Search Results. Rather than browse through often lengthy documents, you can search for specific words and phrases as follows: Portable Document Format / pdf. / Adobe Click on the Search button (illustrated with binoculars). This will open up a search window. Type in the term you need to find and links to all of the references to that term within the document will be displayed in the window. You can jump to each reference by clicking it. You can search for more terms by pressing search again. Word documents Select Edit from the menu, the Find and type in your term in the search box which is presented. The search function will locate the first use of the term in the document. By pressing next you will jump to further references. Definitions from the UK Kidney Federation CAPD (Continuous Ambulatory Peritoneal Dialysis) is the most common type of PD. C stands for Continuous, meaning all the time, and A for Ambulatory, because you can walk around while the dialysis takes place. When people are on CAPD, they do their own fluid exchanges. They drain 1.5 to 3 litres of dialysis fluid into their abdomen, leave it there for 4 to 8 hours, and then drain it out. This is done four to five times a day every day. Exchanges are simple to do and can be performed in any clean area, almost anywhere even in the car by the roadside for people who drive long distances. APD (Automated Peritoneal Dialysis) uses a machine to do the dialysis fluid exchanges. The machine is usually placed in the bedroom and does the exchanges while the person is asleep. Some new APD machines are only the size of a video recorder, and make it possible for people to do exchanges in different places. Most people need to spend 8 to 10 hours attached to the machine every night. This enables the machine to perform an average of three to five exchanges of 1.5 to 3 litres of dialysis fluid each night. The length of time that PD fluid is left in the abdomen before it is exchanged by the machine, varies from between about 30 minutes to 3 hours. After spending the night on the machine, most people on APD keep fluid inside their peritoneum during the day. Some people will need to do one exchange during the daytime, or around teatime. A small number of people use a simple automated machine (sometimes called Quantum) to do one exchange during the middle of the night and then do CAPD by day. Some kidney units offer help at home for people who cannot set the machines up themselves because they do not have the necessary strength or dexterity. A nurse visits the home in the evening to set the machine up, and again in the evening to take the bags off the machine. The person on dialysis just needs to connect themselves onto the machine before going to bed, and disconnect in the morning. This is called Assisted APD. It can help some people where they cannot do all the dialysis themselves, but would prefer not to come into the hospital three times a week for haemodialysis.

4 Guidelines NICE clinical guideline 125 Peritoneal dialysis in the treatment of stage 5 chronic kidney disease (2011) Peritoneal dialysis can be delivered safely and effectively at home or at another location of the patient s choice. Patients administer it themselves although children, and some adults, might need help from their families or carers. Patients must have a clean and hygienic place to exchange dialysis fluid and/or set up dialysis delivery devices either to have dialysis throughout the day (continuous ambulatory peritoneal dialysis [CAPD]) or overnight while they are asleep (automated peritoneal dialysis [APD] and assisted automated peritoneal dialysis [aapd]). A small room or shed will be needed to store deliveries of dialysis fluid. Recommendations To enable patients to make informed decisions, offer balanced and accurate information about all dialysis options. The information should include: a description of treatment modalities (assisted automated peritoneal dialysis [aapd], automated peritoneal dialysis [APD], continuous ambulatory peritoneal dialysis [CAPD], and home or in-centre haemodialysis) including: efficacy risks potential benefits, based on the person s prognosis potential side effects and their severity changing the modality of dialysis and the possible consequences (that is, the impact on the person s life or how this may affect future treatment or outcomes). CLINICAL PRACTICE GUIDELINES Peritoneal Dialysis: UK Renal Association, 5th Edition, 30 July 2010 Guideline 1.1 PD : Equipment and Resources We recommend that Peritoneal Dialysis should be delivered in the context of a comprehensive and integrated service for renal replacement therapies, including haemodialysis (including temporary backup facilities), transplantation and conservative care. Both continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD), in all its forms should be available. Dedicated PD nursing staff (1 W.T.E. per 20 patients) should be part of the multidisciplinary team (1C). We recommend that each unit has a designated lead clinician for PD (1C). Assisted PD should be available to patients wishing to have home dialysis treatment but unable to perform self-care PD. (1C) Rationale: Assisted PD, with provision of nursing support in the community to help with part of the workload and procedures associated with PD, is a useful option to overcome an important barrier to home dialysis therapy 16. Assisted APD should be available for patients, who are often but not always elderly, wishing to have dialysis at home, but are unable to perform self-care PD. 16. Povlsen JV, Ivarsen P. Assisted automated peritoneal dialysis (AAPD) for the functionally dependent and elderly patient. Perit Dial Int 2005; 25 (Suppl 3): S60-S63

5 Table of Contents Search Results 1. Developing an assisted automated peritoneal dialysis (aapd) service-a single-centre experience... page 2 2. Patients treated by peritoneal dialysis: An heterogeneous group of patients. PD patients profiles [French] Les patients traites par dialyse peritoneale : un groupe heterogene de patients. Profils des patients en DP... page 2 3. Assisted peritoneal dialysis is a cost-effective alternative in frail elderly Dutch end stage renal disease patients... page 2 4. Impact of home dialysis on UK healthcare budget... page 3 5. Unplanned start on assisted peritoneal dialysis.... page 4 6. Costs of home assistance for peritoneal dialysis: Results of a European survey... page 4 7. Patients in assisted automated peritoneal dialysis develop strategies for self-care.... page 5 8. Assisted peritoneal dialysis as a method of choice for elderly with end-stage renal disease... page 5 9. 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.... page Peritoneal dialysis in patients with acute renal failure.... page Assisted automated peritoneal dialysis (AAPD) for the functionally dependent and elderly patient.... page 7 Page 1

6 1. Developing an assisted automated peritoneal dialysis (aapd) service-a single-centre experience Citation: NDT Plus, December 2011, vol./is. 4/SUPPL. 3(iii16-iii18), ; (December 2011) Brown N.; Vardhan A. There is an ongoing increase in the number of elderly or frail patients requiring renal replacement therapy. Assisted automated peritoneal dialysis (aapd) is one treatment option for this patient group and is becoming increasingly recognized as a distinct dialysis modality. In this article, we review the current status of aapd and its evolution across Europe, describing the differences in service provision. We also report our experience locally of outcomes on our aapd population over the last 4 years. We found that aapd is a viable dialysis modality in the frail and elderly with limited lifespan, and complications of peritoneal dialysis are perhaps lower than would be expected in this population. This form of therapy also avoids the disruption to life which results from hospital-based dialysis The Author. Journal: Article 2. Patients treated by peritoneal dialysis: An heterogeneous group of patients. PD patients profiles [French] Les patients traites par dialyse peritoneale : un groupe heterogene de patients. Profils des patients en DP Citation: Nephrologie et Therapeutique, July 2011, vol./is. 7/4( ), ; (July 2011) Couchoud C.; Verger C.; Dervaux T.; Ryckelynck J.-P.; Frimat L. French Often, one gathers together under the denomination "peritoneal dialysis" patients with various clinical profiles. To quantify this "heterogeneity" we analysed the clinical characteristics of 32,975 patients treated by dialysis at 31 December 2008 in 22 French regions, participating to the REIN registry. This cross-sectional study confirms our initial hypothesis of a great heterogeneity of patients' profiles in peritoneal dialysis. As in hemodialysis, there is a gradation between modalities: from assisted continuous ambulatory peritoneal dialysis which concerns the frailty patients to autonomous automated peritoneal dialysis for more healthy patients, through assisted automated peritoneal dialysis and autonomous continuous ambulatory peritoneal dialysis Association Societede nephrologie. Published by Elsevier Masson SAS. All rights reserved. Journal: Article 3. Assisted peritoneal dialysis is a cost-effective alternative in frail elderly Dutch end stage renal disease patients Citation: NDT Plus, June 2010, vol./is. 3/(iii94-iii95), (June 2010) Laplante S.; Krepel H.; Simons B.; Nijhoff A.; Van Liere R.; Simons M. Introduction and Aims: With the Dutch population aging, the number of individuals 75 years old or more in need of dialysis is growing. Dialysis can significantly prolong survival in these patients. However, hemodialysis can be perceived as too burdensome as these patients are likely to spend some 50% of their remaining life at or in hospital. Peritoneal dialysis (PD) is an ideal alternative as it is less aggressive; avoids time at or travelling to hospital and limits exposure to hospital pathogens. When informal help is not available, Dutch patients can be institutionalized in a nursing home where PD is performed safely. Providing nursing services at home (assisted PD) can be an alternative. The aim of this analysis was to verify the cost-effectiveness of assisted PD. Methods: A Page 2

7 decision-tree model was constructed in Excel to estimate the cost-effectiveness of assisted automated PD (aapd). Current treatment pathway (conservative management, CM: 40%; APD in nursing home, nhapd: 60%) was compared to a new approach including aapd at home (i.e., CM: 20%, nhapd: 20%, aapd: 60%). Data inputs included survival, quality adjusted life year (QALY) and costs. Survival data came from a weighted average of 3 published studies in this type of patients. Official tariffs (2009) were used for costs, except for conservative management where an assumption of per year was made. Main data inputs for the base case are shown below: (Table presented) Scenario analyses on the 1-year analysis were performed by varying survival rates, costs (+/-10%), QALY (+/-5%) and percent of CM patients (0-40%). Sensitivity analyses on the 5-year analysis were performed by using survival data from the published studies that showed the largest and smallest difference in survival. The healthcare payers perspective was taken. Results: Both 1-year and 5-year analyses showed that aapd is dominant, i.e., more effective and less costly than the current treatment pathway. All scenarios analyzed gave similar results with incremental cost-efficacy ratios ranging from ( to /QALY). Over a 5-year period, offering aapd in addition to CM and nhapd can generate savings of around ( ) per patient to the healthcare payers. Conclusions: Dialysis in frail patients can improve their survival and quality of life significantly. However, these patients are likely to need help to perform the procedure at home. In the absence of a spouse, child or carer, paid help may be necessary. Despite the investment required in home nursing activities, providing aapd in frail elderly ESRD patients is a cost-saving alternative for Dutch healthcare payers. Journal: Conference Abstract 4. Impact of home dialysis on UK healthcare budget Citation: NDT Plus, June 2010, vol./is. 3/(iii91-iii92), (June 2010) Joseph J.; Laplante S. Introduction and Aims: The proportion of UK dialysis patients treated at home (peritoneal dialysis (PD) and home haemodialysis (HHD)) has declined from 30.4% in 2003 to 21% in 2007, while the prevalence of dialysis patients has increased on average by 5% annually over the same period. This decrease in home dialysis is mainly due to a decrease in the proportion of PD patients (28% in 2003 to 19% in 2007). Performing dialysis at home has several advantages over in-centre dialysis. In addition to improved survival, home dialysis is less intrusive on patient's life and limits exposure to hospital pathogens. Thus, these patients are less likely to spend time in hospital. Given choice, 50% of patients will choose PD. As approximately 80% of chronic kidney disease patients are suitable for PD, up to 40% of patients could then be on PD. Figures for HHD are believed to be around 10%, bringing to 50% the proportion of patients that could be treated at home. This analysis was performed to estimate the potential savings that could be generated by increasing the delivery of dialysis at home to 30% (HHD 5%; PD 25%) in the National Health Service (NHS). Methods: A Markov model built in Excel compared the current situation (status quo) forecasted to 2013 to a scenario where 30% of prevalent dialysis population would be at home (HHD 5%; continuous ambulatory PD 8.8%; automated PD (APD) 15%; assisted APD (aapd) 1.2%), leaving 70% to in-centre HD (30% in satellite HD). Data inputs included prevalent patients in the previous 5 years, 2007 incident established renal failure patients, patient flow (dialysis modalities, transplant, and death), incidence of complications and related duration of hospital stay, erythropoietin use, access failure rate, transport costs and nurse to patient ratio. Results: The number of patients on dialysis in the UK is expected to be 30,404 in Extrapolating current trends, only 13.5% would be treated at home (11.1% on PD). Running the dialysis program and managing patient complications would then require a budget of 1 billion nationally (262 million more than 2007 budget). A scenario where the proportion of patients treated at home represents 30% of the patients on dialysis would limit this increase to 159 million. The average annual cost per patient would increase from 32,899 in 2007 to 35,048 with the status quo but would decrease to 31,584 with 30% Page 3

8 being treated at home. The model forecasts that in 2013, a total of 306,797 hospital days would be related to dialysis complications/infections with the status quo compared with 294,385 days in the scenario. The status quo projection requires an additional 771 full time nursing equivalents to run the dialysis program by 2013 compared with 485 for the scenario. Transport costs would also be reduced by 16 million as well as a reduction in erythropoietin usage -by 796 million less units. Conclusions: Increasing the use of home dialysis to 30% in the UK would generate a saving of 103 million to the NHS. This saving is not only derived from the dialysis modality, but also from dialysis related hospitalisations, transport and erythropoietin usage. In addition, this would also help address the expected nursing shortage in the coming years. Journal: Conference Abstract 5. Unplanned start on assisted peritoneal dialysis. Citation: Contributions to Nephrology, 2009, vol./is. 163/(261-3), ; (2009) Povlsen JV The present paper describes a program for an unplanned start on assisted automated peritoneal dialysis for late referred patients with chronic kidney disease stage V and urgent need for initiation of dialysis. Using a standard prescription for 12 h overnight APD right after PD catheter placement, analysis of our data showed that unplanned start on APD has no detrimental effects on patients, combined patient and technique, peritonitis-free survivals or the risk of infectious complications, while the risk of mechanical complications and the need of replacement of displaced or malfunctioning PD catheters may be increased. Unplanned start on APD right after PD catheter insertion is a feasible, safe and efficient procedure. Journal Article MEDLINE 6. Costs of home assistance for peritoneal dialysis: Results of a European survey Citation: Dratwa M. Kidney International, April 2008, vol./is. 73/SUPPL. 108(S72-S75), ; (April 2008) Assisted peritoneal dialysis (apd) was 'invented' in France in 1977 and was immediately very well reimbursed. This has since helped to maintain a high French peritoneal dialysis (PD) penetration rate among elderly dependent patients who might enjoy a better quality of life by remaining in their own environment. The aim of this study was to investigate the present status of apd funding in European countries through a questionnaire sent in 2006 to health authorities and commercial PD providers asking about reimbursement modalities (in euros () per patient per year) for nurse apd. Specific funding for apd only exists in Belgium, Denmark, France, Switzerland, and one region of Spain (Canary Islands). Germany and the United Kingdom are testing pilot schemes. Compared to France, all other countries exhibit significant differences in reimbursement for similar services (performing bag exchanges or disconnections from/to a cycler, exit site care, monitoring weight as well as blood pressure and ultrafiltration, and also including transportation costs) both for continuous ambulatory peritoneal dialysis (CAPD) ( vs 7280 per patient per year in Spain) and automated peritoneal dialysis (APD) ( vs 5356 per patient per year in Belgium); these differences are difficult to understand and might reflect disparities in cost of living, national health-care budget, and/or mean nurses' salaries. Also, there is no correlation between these rates and the reimbursement for PD therapy itself. Only France and Belgium differentiate assisted CAPD and APD, but these differences do not reflect the time really spent at the patient's home. It is concluded that high reimbursement rates for assistance add significant extra cost to PD, but allow Page 4

9 Full Text: granting many dependent patients all the advantages of home therapy, instead of treating them with in-center hemodialysis which in any case still remains more expensive for our societies International Society of Nephrology. Journal: Article Available in fulltext at EBSCOhost 7. Patients in assisted automated peritoneal dialysis develop strategies for self-care. Citation: Full Text: Nephrology Nursing Journal, 01 March 2008, vol./is. 35/2( ), X Holch K journal article CINAHL Available in fulltext at EBSCOhost 8. Assisted peritoneal dialysis as a method of choice for elderly with end-stage renal disease Citation: International Urology and Nephrology, 2008, vol./is. 40/4( ), (2008) Dimkovic N.; Oreopoulos D.G. In the last two decades, most developed countries have seen a continuous growth in the number of elderly patients with end-stage renal disease commencing renal replacement therapy. Despite the many advantages that peritoneal dialysis (PD) offers to elderly patients with ESRD, it is still underutilized in older patients. Older patients are much more vulnerable to the problems associated with aging, which may affect their level of independence and their long-term prognosis. Those patients have physiological changes related to aging and common health problems such as anxiety, depression, dementia, visual impairment, and cognitive impairment, all of which interfere with self-performing PD. Assistance with home-care nurses and assistance by a family member may overcome this problem. Some old but also more recent literature data justifies the idea that assisted PD may significantly contribute to increase the overall number of elderly patients who can be treated with PD at home. With assisted PD, free choice can be offered to patients with high comorbidity index who cannot perform their peritoneal exchanges by themselves. Automated peritoneal dialysis is the ideal treatment modality for elderly patients with end-stage renal disease who require assistance since this limits home-care nurse visits to only two a day. As expected, the elderly have a higher mortality rate than younger patients treated by assisted PD, but technique failure rate, overall peritonitis rate, and most quality-of-life (QoL) measures are comparable with those of younger patients. Peritoneal dialysis in nursing homes offers treatment for elderly patients without family support. In this regard, automated PD or nightly PD keeps the patient's daytime free for nursing home activities, increases socialization, and enables better rehabilitation that improves their QoL. Although withdrawal from dialysis is more frequent among nursing-home dialysis patients, this high discontinuation rate is not due to dialysis per se but rather to associated social and medical circumstances. Better communication between nursing staff and renal team is crucial for improving staff confidence and will contribute to higher utilization of PD in nursing homes. Springer Science+Business Media, B.V Journal: Review 9. 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. Page 5

10 Citation: Nephrology Dialysis Transplantation, April 2007, vol./is. 22/4( ), ; (2007 Apr) Full Text: Verger C; Duman M; Durand PY; Veniez G; Fabre E; Ryckelynck JP BACKGROUND: In France, 48% of home-based peritoneal dialysis (PD) patients require assistance to perform their exchange and manage their treatment. A total of 7% are aided by their family, and 41% by a private nurse. Of all the continuous ambulatory peritoneal dialysis (CAPD) patients, 61.7%, and among automated peritoneal dialysis (APD) patients 23%, are assisted at home for their bag exchanges and connections. Assisted APD patients (AAPD) are more comorbid and elderly so that a home helper is not always available: this explains why most helpers at home are private visiting nurses paid by the National Social Security. In addition to the home helper (nurse or family), 58% of centres make regular additional home visits to check the respect of procedures previously taught during the initial training of the nurse or the family helper. The aim of this study was to evaluate whether the type of home assistance received by dependent patients had an influence on peritonitis rates, and if home visits done by nurses of training centres may improve results.methods: Peritonitis rates and the probability of being peritonitis free were analysed for 1624 new APD patients recorded in the French PD Registry (RDPLF) between 2000 and 2004, and followed-up until early 2005.RESULTS: Nurse-assisted APD patients had a peritonitis rate of one episode every 36 months, and family-assisted patients one episode every 45 months; using Poisson analysis this trend was not significant (P=0.11). However, the probability of being peritonitis free was significantly higher for family-assisted (69.8% at 2 year) compared with home nurse-aided persons (54.4%) after adjustment for age, diabetes and the Charlson comorbidity index. This difference disappeared when nurses from the training centre regularly visited PD patients at their home in the presence of their helper, whichever type of assistance they received. In addition, when the nurses from the training centres visited private nurse-assisted patients, the probability of being peritonitis free was significantly improved in comparison with those persons who did not receive home visits, from 33.9% to 50.8% at 3 years (P=0.028).CONCLUSIONS: APD patients assisted at home by a private nurse have a higher risk of developing peritonitis than family-assisted patients, unless additional regular home visits are organized by the original training centre. Therefore, we recommend that home visits be regularly made for dependent PD patients to optimize the quality of care provided by the helper. Comparative Study; Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't MEDLINE Available in fulltext at Highwire Press 10. Peritoneal dialysis in patients with acute renal failure. Citation: Advances in Peritoneal Dialysis, 2007, vol./is. 23/(7-16), ; (2007) Passadakis PS; Oreopoulos DG Of the two main renal replacement therapies, peritoneal dialysis (PD) was the modality first used for the treatment of patients with acute renal failure (ARF) because of its inherent advantages. Highly trained personnel, expensive and complex apparatus, and systemic anticoagulation were not needed, and so the procedure could be simply and quickly initiated. Further, because of the gradual removal of fluid and solutes, PD results in better hemodynamic stability. Manually or cycler-assisted ("automated") PD has been successfully used in many ARF patients, especially those at risk of bleeding or with hemodynamic instability, and in infants and children with ARF or circulatory failure. Recently, technological developments in hemodialysis techniques (bicarbonate dialysis, hemofiltration, hemodiafiltration) and the continuous renal replacement therapies (CRRTs), have limited the indications for PD in critically ill patients with ARF. In addition, better knowledge about the connection between early and adequate dialysis dose Page 6

11 and improved outcomes has led to a tendency to increase the dialysis dose given to ARF patients, furthering the development of newer techniques. Although PD has been considered less effective than hemodialysis and CRRTs are in patients with severe acute illness (pulmonary edema, poisoning, extreme catabolysis) and ARF, PD remains an effective therapy that is easily and simply instituted, especially for infants and children with ARF, both within and outside of intensive care settings. Journal Article; Review MEDLINE 11. Assisted automated peritoneal dialysis (AAPD) for the functionally dependent and elderly patient. Citation: Full Text: Peritoneal Dialysis International, February 2005, vol./is. 25 Suppl 3/(S60-3), ; (2005 Feb) Povlsen JV; Ivarsen P OBJECTIVE: To describe basic demographics and clinical outcomes among elderly end-stage renal disease (ESRD) patients physically dependent on a caregiver and maintained on an assisted automated peritoneal dialysis (AAPD) program.design: Retrospective single-center study based on patient records and data files.setting: University Hospital.PATIENTS: 64 physically dependent AAPD patients followed for treatment months. Assistance and care was delivered by 52 briefly trained teams of visiting nurses or nursing home staff.result: Crude 1-year survival was 58% and 2-year survival was 48%. Crude 1- and 2-year survivals, excluding deaths within 90 days, were 66% and 54% respectively. We found no significant effect on survival by main causes of ESRD, gender, age, late referral, need for acute start, social isolation, physical dependency on help at inclusion, or residence in a nursing home. 10% of patient-days on AAPD were spent in hospital. 13 (20%) of the patients were converted permanently to hemodialysis due to PD technique failure. The incidence of peritonitis was 1 in every 25.3 treatment-months.conclusions: AAPD may be a feasible and safe option for renal replacement therapy for frail, elderly, and physically dependent patients with ESRD. Despite the special patient selection for this AAPD program, we achieved results of international standards for patient survival, PD technique survival, and incidence of acute peritonitis. These results do notjustify withholding dialysis from this group of patients. Journal Article; Research Support, Non-U.S. Gov't MEDLINE Available in fulltext at Highwire Press Page 7