YAŞLI SON DÖNEM BÖBREK HASTALARINDA ASİSTE PERİTON DİYALİZİNİN KARŞILAŞTIRILMASI

Yıl 2023, Cilt: 9 Sayı: 3, 302 - 308, 01.09.2023

Sümeyra KOYUNCU Cihan UYSAL Sibel AKIN Ali GÜNDOĞDU İsmail KOÇYİĞİT Murat SİPAHİOĞLU Oktay OYMAK Bülent TOKGÖZ

https://doi.org/10.53394/akd.1054948

Öz

Amaç: Renal replasman tedavisi (RRT) alan son dönem böbrek yetmezliği (SDBY) olan yaşlı hastaların sayısında sürekli bir artış olmuştur. Geriatrik SDBY'li bir hasta grubunda birey ve aile üyesi destekli PD arasındaki etkinlik ve komplikasyonları karşılaştırmayı amaçladık.
Yöntem: Bu retrospektif çalışmaya 2017-2019 yılları arasında periton diyalizi ünitesinde SAPD tedavisi gören 65 yaş üstü 50 hasta dahil edildi. Diyaliz yöntemi seçiminden önce hastaların fonksiyonel durumları 6 maddelik günlük yaşam aktiviteleri (ADL) ve 8 maddelik enstrümantal günlük yaşam aktiviteleri (IADL) ile değerlendirildi. Üç yıllık takip sonuçları, diyaliz etkinlik parametreleri ve diyaliz komplikasyonları açısından değerlendirildi.
Bulgular: İki grup arasında yaş, cinsiyet ve biyokimyasal veriler açısından istatistiksel fark yoktu. Ödem, çıkış yeri enfeksiyonu ve sızıntı arasında da fark yoktu; ancak toplam peritonit sayısı ile ilk peritonit atağına kadar geçen süre arasında anlamlı bir fark gözlendi. APD grubunda ilk peritonit atağına kadar geçen süre diğer gruba göre daha kısaydı. Ayrıca asiste PD grubunda total peritonit atak sayısı daha fazlaydı.
Sonuç: Yaşlı SDBY popülasyonu artmakta ve PD kullanımı dünya çapında azalmaktadır. Bununla birlikte, APD iyi yapılmazsa, bu düşüşü tersine çevirmek ve birçok zayıf, yaşlı hastaya güvenli ve başarılı tedavi sağlamak için etkili bir strateji olmayabilir.

Anahtar Kelimeler

asiste, periton diyalizi, geriatri

Destekleyen Kurum

yok

Teşekkür

Erciyes Üniversitesi tıp fakültesi periton diyaliz hemşirelerine teşekkürler

COMPARING INDIVIDUAL- AND FAMILY MEMBER-ASSISTED PERITONEAL DIALYSIS IN ELDERLY END-STAGE RENAL DISEASE PATIENTS

Öz

Aim: There has been a steady increase in the number of elderly patients with end-stage renal disease (ESRD) receiving renal replacement therapy (RRT). We aimed to compare the efficiency and complications between individual and family member-assisted PD in a patient group with geriatric ESRD.
Method: This retrospective study included 50 patients > 65 years of age who received CAPD treatment between 2017-2019 in the peritoneal dialysis unit. Before dialysis modality selection, patients' functional status was evaluated with the 6-item activities of daily living (ADL) and 8-item instrumental daily living activities (IADL). Their three years’ follow-up results were evaluated in terms of dialysis efficiency parameters and dialysis complications.
Results: There was no statistical difference between the two groups regarding their age, gender, and biochemical data. There was also no difference between edema, exit-site infection, and leakage; however, a significant difference was observed between the total number of peritonitis and the time until the first peritonitis attack. The time until the first peritonitis attack was shorter in the APD group than in the other group. Besides, the number of total peritonitis attacks was higher in the assisted PD group.
Conclusion: The elderly ESRD population is increasing, and PD use is declining worldwide. However, if APD is not done well, it may not be an effective strategy to reverse this decline and provide safe and successful treatment to many frail, elderly patients.

Anahtar Kelimeler

elderly, assisted, peritoneal dialysis

Kaynakça

• 1. Murphy D, McCulloch CE, Lin F, Banerjee T, Bragg-Gresham JL, Eberhardt MS, Morgenstern H, Pavkov ME, Saran R, Powe NR, Hsu CY; Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team. Trends in Prevalence of Chronic Kidney Disease in the United States. Ann Intern Med. 2016 Oct 4;165(7):473-481.
• 2. CORR (2006) Canadian Organ Replacement Register (CORR) annual report: treatment of end-stage organ failure in Canada, 1995 and 2004. Canadian Institute for Health Information, Don Mills, ON, Canada.
• 3.Jager KJ, van Dijk PC, Dekker FW, Stengel B, Simpson K, Briggs JD, ERA-EDTA Registry Committee (2003) The epidemic of aging in renal replacement therapy: an update on elderly patients and their outcomes. Clin Nephrol 60:352–360
• 4. Belasco, A., Barbosa, D., Bettencourt, A. R., Diccini, S., & Sesso, R. (2006). Quality of life of family caregivers of elderly patients on hemodialysis and peritoneal dialysis. American Journal of Kidney Diseases, 48(6), 955-963.
• 5. Stel VS, van Dijk PC, van Manen JG et al (2005) Prevalence of co-morbidity in different European RRT population and its effect on access to renal transplantation. Nephrol Dial Transplant 20(12):2803–2811
• 6. Süleymanlar G, Ateş K, Seyahi N. Türkiye 2018 Yılı Ulusal Nefroloji, Diyaliz ve Transplantasyon Kayıt Sistemi Raporu. Ekim 2019: 1-128.
• 7.Guilloteau, S., Lobbedez, T., Guillouët, S., Verger, C., Ficheux, M., Lanot, A., & Béchade, C. (2018). Impact of assisted peritoneal dialysis modality on outcomes: a cohort study of the French language peritoneal dialysis registry. American journal of nephrology, 48(6), 425-433.
• 8.Covic A, Bammens B, Lobbedez T, et al: Educating end-stage renal disease patients on dialysis modality selection: clinical advice from the European Renal Best Practice (ERBP) Advisory Board. Nephrol Dial Transplant 2010; 25:1757–1759
• 9. Couchoud C, Moranne O, Frimat L, Labeeuw M, Allot V, Stengel B: Associations between comorbidities, treatment choice and outcome in the elderly with end-stage renal disease. Nephrol Dialy Transplant 2007;22:3246–3254.
• 10. Brown EA. How to address barriers to peritoneal dialysis in the elderly. Perit Dial Int 2011;31 Suppl 2:S83-5.
• 11.Fan SL, Sathick I, McKitty K, Punzalan S: Quality of life of careguivers and patients on peritoneal dialysis. Nephrol Dial Transplant 2008;23:1713–1719
• 12. S. Katz, T.D. Downs, H.R. Cash, R.C.Grotz .Progress in development of the index of ADL The Gerontologist, 10 (1970), pp. 20-30
• 13. Brown EF, Johansson L, Farrington K et al. Broadening options for long-term dialysis in elderly (BOLDE): Difference in quality of life on peritoneal dialysis compared to hemodialysis for older patients. Nephrol. Dial. Transplant. 2010; 25: 3755–65.
• 14.Griva K, Yu Z, Chan S, Krisnasamy T, Yamin RB, Zakaria FB, et al. Age is not a contraindication to home-based dialysis - Quality-of-Life outcomes favour older patients on peritoneal dialysis regimes relative to younger patients. J Adv Nurs 2014;70(8):1902-14.)
• 15.Mahajan S, Tiwari SC, Kalra V, Bhowmik DM, Agarwal SK. Factors affecting the use of peritoneal dialysis among the ESRD population in India: a single-center study. Perit Dial Int 2004;24(6):538-41.
• 16. Brown EA. Should older patients be offered peritoneal dialysis? Perit Dial Int 2008; 28:444–8.
• 17. Blake PG. Peritoneal dialysis: a “kinder, gentler” treatment for the elderly? (Editorial). Perit Dial Int 2008; 28:435–6
• 18. Béchade C, Lobbedez T, Ivarsen P, Povlsen JV. Assisted Peritoneal Dialysis for Older People with End-Stage Renal Disease: The French and Danish Experience. Perit Dial Int. 2015;35(6):663-666. doi:10.3747/pdi.2014.00344
• 19.Harris SA, Lamping DL, Brown EA, Constantinovici N, North Thames Dialysis Study (NTDS) Group (2002) Clinical outcomes and quality of life in elderly patients on peritoneal dialysis versus hemodialysis. Perit Dial Int 22:463–470
• 20. Obraador GT, Ruthazer R, Arora P, Kausz AT, Pereira BJ (1999) Prevalence of and factors associated with suboptimal care before initiation of dialysis in the United States. J Am Soc Nephrol 10:1793–1800
• 21. Holley JL, Bernardini J, Perlmutter JA, Piraino B (1994) A comparison of infection rates among older and younger patients on continuous ambulatory peritoneal dialysis. Perit Dial Int 14:66–69
• 22. Vecchi AF, Maccario M, Braga M, Scalamogna A, Castelnovo C, Ponticelli C (1998) Peritoneal dialysis in nondiabetic patients older than 70 years: comparison with patients aged 40–60 years. Am J Kidney Dis 31:479–490
• 23. Joner MR, Gehr TW, Burkart JM et al (1998) Replacement of aminoacid and protein loses with 1.1% aminoacid peritoneal dialysis solution. Perit Dial Int 18:210–216.
• 24. Jagose JT, Afthentopoulos IE, Shetty A, Oreopoulos DG (1996) Successful use of continuous ambulatory peritoneal dialysis in octogenarians. Adv Perit Dial 12:126–131
• 25. Dimkovic N, Prakash S, Roscoe J et al (2001) Chronic peritoneal dialysis in octogenarians. Nephrol Dial Transplant 16:2034–2040
• 26. Bargman JM (1993) Complications of peritoneal dialysis related to increased intraabdominal pressure. Kidney Int 40(Suppl):S75–S80
• 27. Gentile DE (1990) Peritoneal dialysis in geriatric patients: a survey of clinical practice. Adv Perit Dial 6(Suppl): 29–32
• 28. Yang X, Fang W, Kothari J et al (2007) Clinical outcomes of elderly patients undergoing chronic peritoneal dialysis: experiences from one center and a review of the literature. Int Urol Nephrol 39:1295–1302
• 29. Jagose JT, Afthentopoulos IE, Shetty A, Oreopoulos D (1996) Successful use of continuous ambulatory peritoneal dialysis in octogenarians. Geriatr Nephrol Urol 5:135–141
• 30. Gokal R, Jabukowski C, King J et al (1987) Outcome in patients on CAPD and haemodialysis: 4 year analysis of a prospective multi centre study. Lancet 2:1105–1109
• 31. Lobbedez T, Moldovan R, Lecame M, de Lignu BH, Haggan WE, Ryckelynck JP (2006) Assisted peritoneal dialysis. Experience in a French Renal Department. Perit Dial Int 26:671–676
• 32.Guilloteau S, Lobbedez T, Guillouët S, Verger C, Ficheux M, Lanot A, Béchade C. Impact of Assisted Peritoneal Dialysis Modality on Outcomes: A Cohort Study of the French Language Peritoneal Dialysis Registry. Am J Nephrol. 2018;48(6):425-433.
• 33. Lan PG, Johnson DW, McDonald SP, et al: The association between peritoneal dialysis modality and peritonitis. Clin J Am Soc Nephrol 2014;9:1091–1097
• 34.Balasubramanian G, McKitty K, Fan SL: Comparing automated peritoneal dialysis with continuous peritoneal dialysis: survival and quality of life difference? Nephrol Dial Transplant 2011;26:1702–1708
• 35. Cheng CH, Shu KH, Chuang YW, Huang ST, Chou MC, Chang HR. Clinical outcome of elderly peritoneal dialysis patients with assisted care in a single medical centre: a 25 year experience. Nephrology (Carlton). 2013 Jun;18(6):468-473.
• 36. Li PK, Law MC, Chow KM et al. Good patient and technique survival in elderly patients on continuous ambulatory peritoneal dialysis. Perit. Dial. Int. 2007; 27 (S2): S196–201.
• 37. Castrale C, Evans D, Verger C et al. Peritoneal dialysis in elderly patients: Report from the French Peritoneal Dialysis Registry (RDPLD) NDT. Nephrology 2010; 25: 255–62