The outcomes of peritoneal dialysis as a process of palliative care in patients with multi-comorbidity and depend on caregivers

Jirayut Janma ¹, Athiwat Kritsuwan ², Nongluk Phuangdokmai², Onrujepat Boonrungsirisap², Mananchaya Supamanee 2,Chaiyaporn Laorchotsombbat², Siribha Changsirikulchai ¹

Nephrology Division ,Department of Internal Medicine, Srinakharinwirot University ¹,
Peritoneal dialysis Unit ,HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University ²

Purpose: To report outcomes of patients who were prescribed peritoneal dialysis (PD) as a palliative care.

Method: Patients with uncorrectable severe comorbidites, bed ridden, advanced cancer or social problems (caregivers, household expense) were discussed by PD care team (nephrologists, PD nurses, and dietitian) and families to do PD as a palliative care. PD prescriptions were composed of 2 exchanges, 4 L of PD volume per day to avoid burden of caregivers. They were allowed to use 2.5% or 4.5% PD solutions to prevent patients having hypervolemia require to hospitalization. Patients and families wanted to do PD until the end of life without changing to hemodialysis. Time on therapy of these patients was calculated.

Result: There were 17 (8 males, 9 females) patients during 2012-2018 who performed PD as a palliative care. All of them were required caregivers in caring processes. Most of them (88.2%) had universal health coverage scheme. The mean (SD) of age at staring PD was 68.9 (12.8) years. Patients with diabetes were 47%. The 41.2% of patients had at least an episode of peritonitis. The 10 from 17 patients (58.8%) were still alive. The most common cause of death was sepsis. The mean (SD) time on therapy was 3 (1.2) years. No patients whom caregivers stopped performing PD from burn out.

Conclusion: The design of PD care and prescription which we reported had acceptable outcomes. We propose PD can be combined as one process in palliative program for patients who have conditions suitable to palliative care.