P1171DIALYSIS PRESCRIPTION FOR THE SPREAD OF PERITONEAL DIALYSIS IN THE ELDERLY PATIENTS CLARIFIED BY THE EXAMINATION OF RELATIONSHIP BETWEEN KT/V AND NURSING CARE LEVEL
Authors: Hiramatsu Makoto , Maruyama Keisuke , Ohnishi Akifumi , Momoki Noriya , Nonaka Keisuke , Nakashima Yuri 
Published: June 2020

Background and Aims

Recently, more elderly patients who are independent or able to live at home with support of family are opting for peritoneal dialysis (PD). And assisted PD becomes the useful cure in the super-aging society. Japanese nursing-care insurance system which began in 2000 is useful for the spread of PD in the elderly.

A purpose of this study is to check the current situation of the PD therapy in the elderly needing care. And it is to plan the spread of assisted PD in the elderly patients.

Method

Of the 789 elderly patients controlled by dialysis at our hospital between 2000 and 2018, 265 patients (33.6%) selected PD. 106 patients (30.1%) of young-old group (65-74 years, n=352), 108 patients (32.6%) of old group (75-84 years, n=331), and 51 patients (48.1%) of oldest old (≧85 years, n=106) started PD.

We studied total Kt/V, total Ccr, volume of urine, volume of dialysate, the bag exchange number and dialysate retention time in 90 PD patients.

We estimated total Kt/V and relations of the nursing care level in elderly PD patients.

The data of patients divided into 4 groups: young group (≦64 years, n=30), young-old group (65-74 years, n=19), old group (75-84 years, n=27) and oldest-old group (≧85 years, n=14). Total Kt/V and relations of the nursing care level between 1 and 5 based on assessment of care requirements in PD patients with or without assisted PD were studied.

Results

The nursing-care insurance acquisition rate of each age group was 3.3%, 18.8%, 51.9%, 78.6% and assisted PD rate was 0%, 21.1%, 55.6%, 92.9%, respectively.

Total urine volume was 759±506 L/day in the independent elderly patients and was 603±433 in the elderly patients with assisted PD.

Dialysate volume was 5.5±2.0L/day in the independent elderly patients and was 4.0±2.1 in the elderly patients with assisted PD (p&lt;0.05).

The daily bag exchange number of times was 3.6±1.0 in the independent elderly patients and was 2.9±1.1 in the elderly patients with assisted PD (p&lt;0.05). The volume of dialysate was 5.5 ±2.0 L/day in the independent elderly patients and was 4.0±2.1 L/day in the elderly patients with assisted PD (p&lt;0.05).

Though total Kt/V did not have the difference in each age group, total Kt/V was 1.74±0.36 in the non-need of nursing care elderly patients and was 1.37±0.30 (p &lt;0.05) in the need of nursing care elderly patients.

Total Kt/V was 1.72±0.30 in the independent elderly PD patients and was 1.53±0.44 in the elderly patients with assisted PD.

Total Kt/V and the nursing care level were significantly inversely correlated (p = 0.011). Total Kt/V and the life independence degree of patients with dementia were significantly inversely correlated (p = 0.001)

Conclusion

Elderly PD patients can achieve improved levels of well-being with low volume peritoneal dialysates. The application of dialysis prescriptions using APD and and/or icodextorin decrease the burden of changing PD bags for elderly patients, nurses and families who support them (assisted PD).

PD for elderly patients will create a paradigm shift of dialysis therapy in the super aging society.