1. ¹Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
2. ²Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
3. ³Health Services Research Unit, London School of Hygiene and Tropical Medicine, University of London, London, UK
4. ⁴Department of Medicine and Community Health Sciences, University of Calgary Institute of Health Economics, Calgary, Alberta, Canada

Correspondence: MJ Oliver, Sunnybrook Health Sciences Centre, University of Toronto, Room A239, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5. E-mail: matthew.oliver@sunnybrook.ca

Received 23 March 2006; Revised 10 November 2006; Accepted 12 December 2006; Published online 31 January 2007.

Abstract

Peritoneal dialysis (PD) may be declining because the elderly often have barriers to self-care PD. The objective of this study was to determine whether the availability of home care increases utilization of PD. In 134 incident chronic dialysis patients (median age 73), 108 (81%) had at least one medical or social condition, which was a potential barrier to self-care PD. Eighty percent of patients living in regions where home care was available were considered eligible for PD compared to 65% in regions without home care (P=0.01, adjusted). Each barrier reduced the probability of being eligible for PD by 26% (odds ratio 0.74, per condition, P=0.02) adjusted for age, sex, predialysis care, in-patient start, and availability of home care. In regions with and without home care, 59 and 58% of eligible patients choose PD when they were offered it (P=NS). The utilization of PD in the incident end-stage renal disease (ESRD) population living in regions with and without home care was 47 and 37%, respectively (P=0.27). The mean rate of home care visits over the first year was 4.3 per week (maximum available was 14 per week). Of the 22 assisted patients, 15 required chronic support, five graduated to self-care, and two started with self-care but later required assistance. Adverse events were similar between assisted PD and traditional modalities. Barriers to self-care PD are very common in the elderly ESRD population but home care assistance significantly increases the number of patients who can be safely offered PD.