Effects of cognitive impairment and assisted peritoneal dialysis on exit-site infection in older patients

Background Elderly peritoneal dialysis (PD) patients required assistance for a variety of PD-related tasks. The usefulness of assisted PD in reducing the peritonitis risk has been reported; however, there is little evidence on the effectiveness of assisted PD in preventing exit-site infections in older patients. Methods This was a single-center, prospective cohort study. Thirty-three patients (mean age: 74.8 +/- 5.9 years) on PD were evaluated for cognitive impairment (CI) using the Japanese version of the Montreal Cognitive Assessment. They were also evaluated to determine whether they performed the exit-site care procedure alone or with assistance. Patients were categorized into four groups based on the presence or absence of CI and the presence or absence of exit-site care assistance. They were followed up until the occurrence of peritonitis and exit-site infection at the end of the follow-up. Results Altogether, 8, 8, and 17 patients were assigned to the without CI and without assistance, without CI and with assistance, and with CI and with assistance groups, respectively; no patients were assigned to the with CI and without assistance group. Six and 16 patients experienced peritonitis and exit-site infection during follow-up, respectively. Kaplan-Meier analysis and log-rank tests revealed that the without CI and without assistance group was significantly associated with exit-site infection (log-rank < 0.05). Conclusion Patients who did not receive assistance for exit-site care were at a higher risk of exit-site infections, even in the absence of CI. Caregiver assistance is important for preventing exit-site infections in older patients on PD.

Automated summary

The study aims to examine the effectiveness of assisted peritoneal dialysis (PD) in preventing exit-site infections in older patients. The results show that even in the absence of cognitive impairment, older patients who do not receive assistance for exit-site care are at a higher risk of developing exit-site infections.