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Kidney Week

Abstract: PO1265

Patient Outcomes of a Two-Exchange Assisted Continuous Ambulatory Peritoneal Dialysis (CAPD) Programme for Frail Older Patients

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Ryan, Louise A., Imperial College Healthcare NHS Trust, London, London, United Kingdom
  • Chelapurath, Titus, Imperial College Healthcare NHS Trust, London, London, United Kingdom
  • Corbett, Richard W., Imperial College Healthcare NHS Trust, London, London, United Kingdom
  • Brown, Edwina A., Imperial College Healthcare NHS Trust, London, London, United Kingdom
Background

Recognising the burden that hospital haemodialysis (HD) places on frail people in terms of time away from home, transport and haemodynamic shifts, we developed a 2-exchange assisted CAPD (aCAPD) programme to enable this group to receive a home-based therapy. Eligible patients include frail, mostly elderly patients who are symptomatic from advanced kidney disease and have residual kidney function. The focus of the programme is to optimise patients’ symptoms while avoiding a high treatment burden.

Methods

In this observational study, all 2-exchange aCAPD patients attending for routine review are approached for assessment. Frailty is assessed with the Edmonton Frail Scale (EFS), cognitive function with the Montreal Cognitive Assessment (MOCA), treatment satisfaction with the Renal Treatment Satisfaction Questionnaire (RTSQ) and symptoms with the Palliative Outcome Scale-Symptom Renal (POS-S Renal). Data was collected via patient interviews and chart review.

Results

Of the 17 patients currently receiving 2-exchange aCAPD, results have been collected from 47% (N=8) to date. Mean age is 82 years (77-90) and 50% are male. Mean number of co-morbidities was 4.4. Mean time on 2-exchange aCAPD was 9 months (0-24). 63% had at least mild frailty with an EFS of >8/17 (3-11). 75% had memory impairment with a MOCA <26/30 (8-30). Median number of hospital admissions was 1 (0-3). 38% have travelled outside of the UK (with family support) since commencing aCAPD. 85% reported high satisfaction with treatment with a RTSQ of >55/66 (median 62). Patients reported a low symptom score with a median POS-S Renal of 14.5 (7-27). Pain, lack of energy and poor mobility were the most commonly reported symptoms.

Conclusion

Our results demonstrate a frail, elderly population with multiple co-morbidities. Although our population number is small and they are not matched to the assisted PD and HD populations published in the FEPOD study they do compare favourably in terms of the RTSQ score; median of 60 vs 55 for assisted PD and 60 vs 51 for HD. Our population was comparable to both groups in terms of the POS-S Renal symptom scores; 14.5 vs 14 for assisted PD and 14.5 vs 16 for HD. This indicates that 2-exchange aCAPD could potentially become the dialysis modality of choice for the frail, older person requiring dialysis.