1. ’10 slides on peritoneal dialysis in older CKD patients’
Dr Helen Hurst
Advanced Nurse Practitioner
Manchester Royal Infirmary

2. What is Peritoneal Dialysis (PD) ?
Peritoneal Dialysis is a home based therapy that should be offered to all patients with CKD 5
It involves placement of PD catheter into the peritoneum where dialysis fluid (glucose based) is exchanged
Fluid dwells for 2-4 hours so toxins and fluid are removed
Traditionally it relied on patients being totally self caring
Older patients in the past has not always had equal access to PD due to perceived barriers.
Programmes are now offering assisted PD to help address the imbalance

3. CAPD exchange
The PD prescription is set by the PD team/nephrologist, the patient usually performs 3-4 exchanges per day ideally in a clean environment
PD prescriptions are tailored to the individual
The procedure has five parts:
Connect
Drain
Flush before fill
Fill
Disconnect

4. APD Automated Peritoneal Dialysis
The cycler performs exchanges/cycles automatically while patient is sleeping
The patient connects when going to bed and disconnects in the morning
There is usually a long dwell during the day

5. PD and the Older Patient
Like all patients it should be offered and choice should be given
Many older patients have assisted APD where staff go in daily to set up the machine, the patient has to connect and disconnect
CAPD can be offered with assistance from one of the dialysis companies
Family/carers and often nursing homes will do all of the therapy
However many older patients are motivated and can be totally self caring……as always it is individualised !

6. Staying at Home
The aim is try and keep people at home and avoid the burden of hospital based Haemodialysis
For older patients this is often why they choose PD
Daily BP and weight are required to monitor fluid status
Daily dressings are also required of the PD exit site

7. Follow local ANTT procedure
The position on the abdomen from which the peritoneal dialysis catheter emerges.
What is the “exit site”?
Use soft material (e.g. swabs) and make sure that material fibres do not become caught in the tunnel
Patients are advised to do dressings after every shower on alternate days
Individual centers may use different antiseptic solutions, but a non-irritant solution be used.
You should use sterile saline solution once you think that the site has healed.
Follow local ANTT procedure
Some units follow guidelines for daily application of mupirocin ointment or gentamicin but local policy varies.
Make bigger.

8. Older People and PD Common problems with PD:
Infection which can be peritonitis and appears as cloudy fluid/and/or abdominal pain (patients must attend the hospital for treatment) or exit site infection when there is pus/redness which requires oral antibiotics
Problems with fluid management: all patients are give a target weight or ideal weight and can adjust the prescription to help remove fluid; many patients still pass urine

9. Older People and PD Other problems:
Social and psychological problems are common in all groups but with an older patient loss of support, living alone, depression can cause difficulties with managing a home therapy.
Offering as much support as possible is vital
With older patients expectations of the treatment should be discussed regularly and many units used advanced care plans which should be communicated/discussed with primary care.

10. The Future
The growing older population poses many challenges to health
PD at home offers an ideal treatment for many of this group
Utilising services that are available in the community needs to be encouraged and engaged with to provide good support structures for this population