The Most Recent Trends of Peritoneal Dialysis in Japan

By 31 December 2006, more than 260 000 patients were on dialysis therapy in Japan, and 9243 of them (3.6%) were on peritoneal dialysis (PD). The mean age of PD patients was 5 years less than that of all patients with chronic kidney disease, and the prevalence of diabetes among them was 9.4% lower. Among the PD patients, 18.0% were being treated with a combination of PD and hemodialysis, and 33.4% were being treated with automated PD. A peritoneal equilibration test (PET) had been performed in 22.0% of the patients, who were then classified into the four PET categories. Of the tested patients, 10.3% were placed in the low (L) category; 38.3% in the low-average (LA) category; 38.4%, in the high-average (HA) category; and 13.0%, in the high (H) category. Icodextrin was used by 27.3% of patients classified L, 30.5% of those classified LA, 47.1% of those classified HA, and 55.1% of those classified H. The annual death rate was 6.1%, which was lower than the rate for HD (9.7%); and the annual withdrawal rate was 19.8%. Infectious complications were the main cause for lowered rates of patient and technique survival. Use of PD for older and diabetic patients and of combination therapy with hemodialysis are key perspectives in the most recent report on PD in Japan.

Quality of Life in Elderly Continuous Ambulatory Peritoneal Dialysis Patients

Objective

In the present study, we determined the characteristic of quality of life (QOL) in elderly peritoneal dialysis (PD) patients by using the Medical Outcomes Study Short Form 36 (SF-36) to compare QOL between two age groups of continuous ambulatory PD patients.

Patients and Methods

Patients were allocated to one of two groups according to age: patients in group A were ≥65 years of age, and patients in group B were <65 years of age. We compared SF-36 scores, serum albumin, prealbumin, hemoglobin, lipid profile, normalized protein catabolic rate (nPCR), dialysis adequacy (Kt/V), creatinine clearance (CCr), and glomerular filtration rate (GFR) between the two groups.

Results

Group A contained 25 patients, and group B, 53 patients. Mean age in the two groups was 68.6 ± 3.3 years and 47.7 ± 10.2 years respectively. Elderly patients showed lower QOL scores with regard to physical problems. Quality-of-life scores with regard to psychological problems were similar in the two groups. Duration of PD, body mass index, serum albumin, prealbumin, hemoglobin, and lipid profile were not different between the two groups. However, nPCR, GFR, and total solute clearance were lower in group A than in group B (nPCR: 0.70 ± 0.13 g/kg daily vs 0.95 ± 0.21 g/kg daily, p < 0.001; GFR: 1.03 ± 1.21 mL/min vs 3.19 ± 2.22 mL/min, p < 0.001).

Conclusions

In elderly patients, QOL scores were lower, mainly because of a perception of being more physically impaired. Nutritional indices and QOL scores reflecting psychological processes were similar between the two groups. These descriptive data show that PD is an ideal choice in elderly patients with end-stage renal disease. More attention needs to be paid to “healthy start” dialysis and maintenance of nutritional status in elderly patients because of lower GFR and nPCR.

Quality of Life, Perceptions, and Health Satisfaction of Older Adults with End-Stage Renal Disease: A Systematic Review

OBJECTIVES

To explore the quality of life (QOL), perceptions, and health satisfaction of older adults with end-stage renal disease (ESRD) undergoing renal replacement therapy (RRT).

DESIGN

Systematic review of literature.

PARTICIPANTS

Individuals with ESRD undergoing RRT aged 65 and older.

MEASUREMENTS

Articles identified from PubMed database search from January 1994 to December 2014. The methodological quality of each of the selected articles was assessed using eight standards adapted from well-established research quality review criteria.

RESULTS

Of the initial 1,401 articles identified, 23 met the inclusion criteria. The age range of study participants examined was 65 to 90. Seventy-eight percent of the studies met six or more of the methodological standards; 47% found overall health-related and mental component summary QOL scores in elderly adults with ESRD to be similar to or higher than those of age-matched controls or younger individuals, although the physical component summary QOL scores tended to be lower in older adults. Only six studies addressed health satisfaction and perceptions of elderly adults with ESRD, with widely variable findings.

CONCLUSION

Few studies specifically examine QOL in elderly adults with ESRD undergoing RRT and even fewer address issues of perceptions and health satisfaction. However, the limited data from the QOL studies looks promising with a significant proportion showing similar or higher overall health-related and mental component summary QOL scores in elderly adults with ESRD. The very limited data on perceptions and health satisfaction of elderly adults with ESRD undergoing RRT makes it difficult to make any generalizable conclusions. Overall, more research is needed to examine these factors in elderly adults with ESRD.

Age is not a contraindication to home-based dialysis - Quality-of-Life outcomes favour older patients on peritoneal dialysis regimes relative to younger patients

AIM

To compare Quality of Life, anxiety and depression between older (≥65 years) and younger (<65 years) patients across automated peritoneal dialysis and continuous ambulatory peritoneal dialysis.

BACKGROUND

There is a lack of studies as to whether the different peritoneal dialysis modalities confer similar outcomes in older and younger patients.

DESIGN

Cross-sectional.

METHODS

A total of 201 patients completed the Kidney Disease Quality of Life Short-Form, World Health Organization Quality of Life Instrument, Short Form and Hospital Anxiety and Depression Scale. Comorbidity and biochemical values were abstracted from medical records.

RESULTS

Older patients reported significantly better quality of life than younger patients in the Kidney Disease Quality of Life Short-Form effects of kidney disease and patient satisfaction and the World Health Organization Quality of Life Instrument overall Quality-of-Life/health despite worse clinical profile. Quality of life outcomes were comparable between automated peritoneal dialysis and continuous ambulatory peritoneal dialysis with the exception of the Kidney Disease Quality of Life Short-Form symptoms in favour of automated peritoneal dialysis. Levels of anxiety and depression were equivalent for older and younger patients across peritoneal dialysis modalities. The observed quality-of-life advantages for older patients persisted after case-mix adjustments and extended to more quality-of-life domains and depression and anxiety.

CONCLUSION

Our findings of superior quality of life in patients aged ≥ 65 support the expansion of peritoneal dialysis use in older patients. Patients across different age groups should be given non-biased information about both peritoneal dialysis modalities and individual preferences should be elicited and carefully considered by healthcare providers.

PSYCHOSOCIAL FACTORS IN PATIENTS WITH CHRONIC KIDNEY DISEASE: Quality of Life and Psychological Issues in Peritoneal Dialysis Patients

Both peritoneal dialysis (PD) and hemodialysis (HD) patients have diminished quality of life (QOL) scores compared to healthy patients. QOL tends to decline over time, with the perception of the quality of physical health deteriorating more than mental health. However, many patients continue to feel hopeless, anxious, and worry about finances, loss of sexual function, family burden, and loss of independence. Depression is the most widely acknowledged psychosocial factor seen in patients with chronic kidney disease. Major depression occurs in 25% of patients facing impending dialysis. Once on PD, the proportion with major depression sharply declines to approximately 6%. This may be due to adjustment to dialysis, but may also be because depressive symptoms are associated with an increased risk of death. A low QOL score and depression are associated with higher comorbidity, poorer nutritional status, anemia, lower residual renal function, and increased hospitalization rates. Increased depressive scores are independently predictive of an elevated peritonitis risk, perhaps due to inattentiveness, or alternatively from a decrease in immune defenses. Small molecule clearances appear to have little to do with depressive symptoms. Depression is a significant problem in PD and other dialysis patients. There is an interrelationship between psychosocial factors, perception of illness, and clinical outcome that requires further study. Serial and simple measures of both depression and QOL should be obtained routinely in all PD patients. This permits rapid recognition of problems and may enhance patients' education on the importance of depression. Further research on interventions is urgently needed.

Quality of life in the elderly patients on dialysis

The pattern of end-stage renal disease (ESRD) has changed significantly with the emerging predominance of elderly patients. Age is no longer seen as a contraindication to dialysis. Based on 2004 data, in the USA, patients aged 45-64 years old comprise the largest portion of the incident population, while patients aged 75 and older have the highest incident rates of ESRD. Mortality is higher among the elderly dialysis patients for whom cardiovascular diseases and infections are the most common causes of death. The quality of life (QoL) of these patients has been found to vary in different investigations, dependent on such factors as the investigator(s), the composition of the study group and the criteria used, among others; however, age was always found one of the major determinants of their QoL. Quality-of-life data suggest that older dialysis patients have similar levels of social functioning and mental health as younger dialysis patients but that their level of physical functioning is poorer. As such, the survival and QoL of elderly patients depends mainly on the severity of the comorbid conditions. The rationing of dialysis on the basis of age alone is not justified as dialysis can provide elderly patients with the means to gain the health status that permits them to enjoy life, but in their own way.