Comparison of Survival Between Assisted Peritoneal Dialysis and Self-Care Peritoneal Dialysis Patients Aged 70 or Older

Comparison of Survival Between Assisted Peritoneal Dialysis and Self-Care Peritoneal Dialysis Patients Aged 70 or Older | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of Survival Between Assisted Peritoneal Dialysis and Self-Care Peritoneal Dialysis Patients Aged 70 or Older Qianhui Song, Hao Yan, Zanzhe Yu, Zhenyuan Li, Jiangzi Yuan, Zhaohui Ni, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-154229/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Assisted PD is used as an alternative option for the growing group of frail, older ESRD patients unable to perform their own PD. This study was undertaken to investigate the outcomes of assisted PD in older patients by comparing assisted PD patients with self-care PD patients. Methods This study included all patients aged 70 or older who started on PD in our hospital from 2009 to 2018. Patients were divided into assisted PD group and self-care PD group according to the independence of bag exchange, and followed up until death, PD cessation or to the end of the study (December 31, 2019). Survival curves were generated using the Kaplan-Meier method and risk factors associated with mortality, peritonitis and technique failure were evaluated using both cause-specific hazards and subdistribution hazards models. Results 180 patients were enrolled, including 106 (58.9%) males with a median age of 77.5 (77.2–81.2) years. Among the 180 patients, 62 patients (34.4%) were assisted. Patients in the assisted PD group were older, more likely to be female, more prevalent in DM and CVD, with a higher Charlson score than patients in the self-care PD group (P all < 0.05). In the multivariable analysis, assisted patients had a comparable patient survival and peritonitis-free survival compared to self-care PD patients either in the Cox or in the FG models. According to a Cox model, the use of assisted PD was associated with a lower risk of technique failure (cs-HR 0.20, 95% CI 0.04–0.76), but the association lost its statistical significance in the Fine and Gray model. Conclusions No significant difference in patient survival and peritonitis-free survival were found between the assisted PD patients and self-care PD patients. Moreover, assisted PD might protect older patients incapable of self-care from technique failure. Therefore, we suggested that assisted PD could be a safe and effective RRT modality for older ESRD patients who need assistance. Geriatrics & Gerontology Assisted peritoneal dialysis older adults patient survival technique survival peritonitis-free survival Figures Figure 1 Figure 2 Introduction With the aging of the general population, the number of older individuals developing end-stage renal disease (ESRD) continues to rise worldwide, accompanied by a much greater demand for renal replacement therapy (RRT) among the older 1 , 2 . There was no common consensus to deliver either HD or PD to the older ESRD patients, and several studies suggested comparable or better outcomes with PD among older patients 3 – 6 . Compared with in-center hemodialysis, peritoneal dialysis offers many potential benefits to older patients, such as less intervention in lifestyle, no need for vascular access, fewer hemodynamic variations and cost-effective, etc. 7 When life expectancy is perceived to be short, quality of life (QoL) may be the priority for older patients, especially the “old older”. PD has also been shown to be associated with better quality of life (QoL) and higher satisfaction with treatment 3 , 5 , 8 . However, barriers to self-care PD including multimorbidity, physical disabilities and psychosocial problems often emerged with increasing age 9 , 10 . Assisted PD is defined as PD treatment performed at the patient’s home and with the assistance of a family member, a partner, a community nurse or a healthcare technician 11 . As a feasible option for patients who cannot perform their own PD exchanges, assisted PD have been developed in many countries with the aim of overcoming barriers in older and non-self-sufficient patients, and some studies suggested that the use of assisted PD could increase the utilization of PD patients among older 12 – 14 . However, whether assisted PD achieved similar outcomes to self-care peritoneal dialysis still remained controversial 15 . Therefore, we conducted the present study to investigate the outcomes of assisted PD in ageing patients, by comparing patients undergoing assisted PD with those on self-care PD in a cohort of older patients. Materials And Methods Patients In our study, the cut-off for the definition of an ‘older’ individual was 70 years of age. All incident patients aged 70 or older who started on PD between 1 January 2009 and 31 December 2018 at Renji Hospital, Shanghai Jiao Tong University School of Medicine, China, were screened for eligibility. Patients had history of maintenance HD/transplantation, withdrew from PD within 3 months or with incomplete data were excluded from the study. All enrolled patients were dialyzed using lactate-buffered glucose-based PD solutions (Dianeal®, Baxter) with twin-bag system. Patients and their caregivers had received standard training after catheterization by PD dedicated nurses 16 . The study was approved by the Human Research Ethics Committee of Renji Hospital, Shanghai Jiao Tong University School of Medicine. All individual information was securely protected and was made available to only the investigators. Demographic and laboratory data The demographic characteristics collected at baseline included age, gender, height, weight, underlying cause of ESRD and comorbid condition status such as diabetes mellitus (DM) and cardiovascular disease (CVD). Hypertension and diabetes were defined either as a comorbid disease or as the etiology of ESRD. CVD was defined as a previous history of any following condition: acute coronary syndrome, heart failure, cerebral infarction or hemorrhage, coronary artery atherosclerosis confirmed by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) therapy. The Charlson comorbidity index was adopted to reflect the burden of comorbid conditions. Body mass index (BMI) was calculated as the weight (kg) divided by the square of height in meters (BMI =weight [kg]/ height [m2]). Baseline laboratory parameters included hemoglobin, serum albumin, creatinine, urea nitrogen, uric acid, sodium, potassium, corrected calcium, phosphate, intact parathyroid hormone (iPTH), total cholesterol, total triglycerides, high-sensitivity C reaction protein (hs-CRP), estimated glomerular filtration rate (eGFR) (mL/min/m2) and fasting blood glucose were collected. The corrected calcium (mmo1/L) = total calcium (mmol/L) + (40- albumin) × 0.025 (mmol/L). Small solute clearance and peritoneal transport characteristics All patients were evaluated small solute clearance and performed a standard peritoneal equilibration test (PET) 1-3 months after PD initiation. Small solute clearance was assessed by 24-h dialysate and urine collection, with the calculation of total weekly Kt/V and weekly CrCl normalized to 1.73m2 body surface area 17 . Residual renal function (RRF) was calculated as an average of 24-h urine urea and creatinine clearance 18 . Normalized protein catabolic rate (nPCR) was calculated by the methods described by Randerson, Chapman, and Farrell and normalized to standard body weight (total body water/0.58) 19 . Patient follow up The enrolled patients were divided into assisted PD group (PD exchanges performed by a family member or a domestic helper) and self-care PD group according to the independence of bag exchange, and prospectively followed up until death, transfer to permanent hemodialysis, recovery of renal function, transfer to other centers, lost to follow-up or to the end of study (December 31st, 2019). All deaths, switches to HD and peritonitis episodes during the study period were carefully tracked and recorded. Detailed causes of death, switches to HD and outcome of peritonitis during PD were also collected. Causes of death were grouped in broad categories as follows: cardiovascular, including cardiac, cerebrovascular, peripheral vascular and sudden death; infection, including peritonitis and non-peritonitis infections; cancer; gastrointestinal hemorrhage; other and unknown causes. Causes of switch to HD were grouped into peritonitis; catheter complications; inadequate dialysis and other causes. Peritonitis was diagnosed and managed in accordance with guidelines of the International Society for Peritoneal Dialysis 20 , and peritonitis rate was calculated as number of peritonitis episodes per patient-year at risk. Outcome measures Outcome measures in our study included patient survival, peritonitis-free survival and technique survival. In patient and peritonitis-free survival analysis, the endpoint was death and first episode of peritonitis, respectively. In technique survival analysis, the endpoint was permanent transfer from PD to HD. For both patient and peritonitis-free survival analysis, the censored events were transfer to permanent hemodialysis, recovery of renal function, loss to follow-up, transfer to other dialysis centers, or to the end of study (December 31st, 2019). In technique survival analysis, the endpoint was permanent transfer from PD to HD, and death was regarded as censored event. Statistics analysis The Kolmogorov–Smirnov test was used to measure data normality. Parametric data were presented as mean ± standard deviation. Nonparametric data were described by the median value (first and third quartile). Categorical variables were presented by frequencies and percentages and were compared using chi-square tests. Normally distributed continuous variables and abnormally distributed continuous variables were compared using the independent sample t-tests and Mann-Whitney test, respectively. Kaplan-Meier and log-rank test methods were used to estimate and compare survival curves for each event of interest (death, peritonitis and transfer to HD) by comparing assisted PD group with self-care PD group. Considering the presence of competing events in this study, for multivariate analysis, risk factors for all-cause mortality, peritonitis and technique failure were evaluated by both cause-specific hazards and subdistribution hazards models 21 . When the event of interest was peritonitis, transfer to HD, renal transplantation, death and transfer to other centers were coded as competing events only when occurring before the first peritoneal infection. When the event of interest was death, the competing events included transfer to HD, renal transplantation and transfer to other centers. When the event of interest was technique failure, the competing events included death, renal transplantation and transfer to other centers. Data analysis was carried out using the SPSS software package (version 22.0: SPSS, Chicago, IL, USA) and R 3.6.1 (R Foundation for Statistical Computing, Vienna, Austria; the ‘cmprsk’ library was used to fit the Fine and Gray regression models). All probabilities were two-tailed, and a p< 0.05 was considered statistically significant. Results Study participants A total of 180 patients were included in present study. Patient enrollment and follow-up were presented in Fig. 1 . Patient characteristics were summarized in Table 1 . Among the 180 patients, 62 needed assistance in performing bag exchanges (“assisted PD group”), and the remaining 118 patients were in the self-care PD group. Patients in the assisted PD group were older (80.7 (76.9–84.0) vs 75.6 (72.5–79.2) years, P < 0.001), less likely to be male (48.4% vs 64.4%, P < 0.05), more prevalent in diabetes (48.4% vs 33.1%, P < 0.05) and CVD(46.8% vs 29.7%, P < 0.05), with a higher Charlson score (7.0 (6.0–8.0) vs 6.0 (5.0–7.0), P < 0.001) than those in the self-care PD group, and other demographic and laboratory data were similar between the two groups. Table 1 Demographic and laboratory data of the study patients Variable All PD patients (n = 180) Assisted PD group (n = 62) self-care PD group (n = 118) P value Age (years) 77.5 (77.2–81.2) 80.7 (76.9–84.0) 75.6 (72.5–79.2) < 0.001 Gender (male) [n (%)] 106 (58.9) 30 (48.4) 76 (64.4) 0.038 BMI (kg/m 2 ) 22.6 (20.4–24.7) 21.9 (20.3–25.0) 23.1 (20.4–24.6) 0.606 Charlson’s comorbidity index 6.0 (6.0–7.0) 7.0 (6.0–8.0) 6.0 (5.0–7.0) < 0.001 Primary renal disease [n (%)] Chronic glomerulonephritis 46 (25.5) 17 (27.4) 29 (24.6) 0.678 Diabetic nephropathy 38 (21.1) 16 (25.8) 22 (18.6) 0.263 Hypertension 11 (6.1) 3 (4.8) 8 (6.8) 0.850 Polycystic kidney disease 2 (1.1) 0 (0) 2 (1.7) 0.546 Others 20 (11.1) 6 (9.7) 14 (11.9) 0.657 Unknown 63 (35.0) 20 (32.3) 43 (36.4) 0.576 Comorbidity [n (%)] Diabetes mellitus 69 (38.3) 30 (48.4) 39 (33.1) 0.044 Hypertension 157 (87.2) 56 (90.3) 101 (85.6) 0.366 Cardiovascular disease 64 (35.6) 29 (46.8) 35 (29.7) 0.023 others 41 (22.8) 16 (25.8) 25 (21.1) 0.482 Baseline Laboratory results* Hemoglobin (g/L) 86.7 ± 16.8 83.9 ± 15.5 88.2 ± 17.4 0.110 Albumin (g/L) 33.1 (29.1–36.4) 33.1 (28.8–36.3) 32.9 (29.9–36.6) 0.998 Creatinine (mmol/L) 663.0 (527.9–789.0) 628.5 (486.8-791.5) 674.3 (555.2-796.8) 0.231 Blood urea nitrogen (mmol/L) 26.5 (21.0-32.2) 27.6 (21.2–33.6) 26.4 (21.0-31.4) 0.405 Uric acid (mmol/L) 487.5 ± 132.0 480.4 ± 130.4 491.2 ± 133.2 0.606 Estimated glomerular filtration rate (eGFR) (mL/min/m 2 ) 5.7 (4.5–7.2) 5.4 (4.4–7.9) 5.7 (4.5-7.0) 0.686 Sodium (mmol/L) 138.1 (136.0-142.0) 138.4 (137.0-141.2) 138.1 (136.0-142.0) 0.175 Potassium (mmol/L) 4.1 ± 0.8 4.1 ± 0.8 4.2 ± 0.7 0.590 Total cholesterol (mmol/L) 4.5 (3.8–5.2) 4.7 (3.7–5.2) 4.5 (3.9–5.4) 0.395 Total triglycerides (mmol/L) 1.3 (1.0-1.8) 1.2 (0.9–1.7) 1.4 (1.0-1.8) 0.154 Corrected calcium (mmol/L) 2.1 (2.0-2.3) 2.2 (2.0-2.3) 2.1 (2.0-2.3) 0.972 Phosphate (mmol/L) 1.8 (1.5–2.1) 1.8 (1.4–2.1) 1.8 (1.5-2.0) 0.784 Intact parathyroid hormone (iPTH) (pg/L) 275.2 (160.5–423.0) 264.0 (171.2-410.5) 285.0 (137.0-424.7) 0.938 Hs-CRP (mg/L) 4.5 (1.3–13.5) 3.8 (1.5–13.8) 5.0 (1.2–13.9) 0.654 Fasting blood glucose (mmol/L) 5.0 (4.4–5.6) 4.9 (4.5–6.1) 4.4 (4.4–5.5) 0.537 Values expressed as mean ± standard deviation, median (25th – 75th percentile), or absolute numbers with percentages [n (%)] Abbreviations : BMI: body mass index, Hs-CRP: high-sensitivity C reaction protein, Corrected calcium: total calcium (corrected by albumin), Kt/Vurea: urea kinetics; CrCl: creatinine clearance; RRF: residual renal function; nPCR: normalized protein catabolic rate; D/Pcr: peritoneal transport characteristics Baseline Laboratory results* was evaluated at PD initiation (within one week before PD catheterization) The indices of small solute clearance, RRF, nPCR and peritoneal transport characteristics (D/Pcr) were shown in Table 2 and there was no difference between the two groups. Table 2 Small solute clearance and peritoneal transport characteristics Variable All PD patients (n = 180) Assisted PD group (n = 62) self-care PD group (n = 118) P value Small solute clearance Total Kt/V urea 2.08 (1.74–2.43) 2.10 (1.78–2.50) 2.07 (1.70–2.41) 0.460 Total CrCl (L/week/1.73m 2 ) 68.9 (55.9–87.2) 68.8 (54.0-92.1) 68.9 (55.9–86.7) 0.744 RRF (ml/min/1.73m 2 ) 3.09 (1.67–5.04) 3.03 (1.62–5.24) 3.05 (1.64–5.09) 0.931 nPCR (g/kg/day) 0.82 (0.71–0.96) 0.82 (0.72–0.95) 0.82 (0.70–0.97) 0.930 D/Pcr 0.65 (0.56–0.75) 0.66 (0.56–0.71) 0.64 (0.57–0.75) 0.994 Values expressed as mean ± standard deviation, median (25th – 75th percentile), or absolute numbers with percentages [n (%)] Abbreviations : Kt/Vurea: urea kinetics; CrCl: creatinine clearance; RRF: residual renal function; nPCR: normalized protein catabolic rate; D/Pcr: peritoneal transport characteristics Patient Outcomes Patient outcomes were summarized in Table 3 . The median follow-up was 32.5 months (inter-quartile range, 20.7–43.7 months) for the assisted PD group and 33 months (inter-quartile range, 12.9–49.7 months) for the self-care PD group. By the end of the study, 100 (55.6%) patients died, 16 (8.9%) patients switched to HD, 6 (3.3%) patients were transferred to other centers, 1 (0.6%) patient was lost to follow-up, 1 (0.6%) patient was dialysis-independent and 54 (30.0%) patients were still on PD. The causes of death were similar in two groups and the leading cause of death was cardiovascular disease (30.0%), followed by infection (27.0%), unknown causes (14.0%), cancer (12.0%), other causes (11.0%) and gastrointestinal hemorrhage (6.0%). During the study period, a total of 101 episodes of peritonitis were recorded. The peritonitis rate was 0.155 episode per patient-year in the assisted PD group and 0.216 episode per patient-year in the self-care PD group, respectively. By the end of the study, a total of 16 patients transferred to HD. The reasons for transferring to HD were similar in two groups and peritonitis was responsible for 7/16 (44%) of transferring to HD. Table 3 Outcomes of the patients Variable All PD patients Assisted PD group self-care PD group P value Follow-up (months) 32.5 (15.7–42.7) 32.5 (20.7–43.7) 33.0 (12.9–49.7) < 0.001 Outcomes [n (%)] n = 180 n = 62 n = 118 Death 100 (55.6) 39 (62.9) 61 (51.7) 0.150 Transfer to HD 16 (8.9) 3 (4.8) 13 (11.0) 0.166 Transfer to other centers 6 (3.3) 0 (0) 6 (5.1) 0.095 Recovery of renal function 2 (1.1) 1 (1.6) 1 (1.0) 1.000 Dialysis independent 1 (0.6) 0 (0) 1 (1.0) 1.000 Lost to follow-up 1 (0.6) 0 (0) 1 (1.0) 1.000 Still on PD 54 (30.0) 19 (30.6) 35 (29.7) 0.891 Causes of death [n (%)] n = 100 n = 39 n = 61 Cardiovascular disease 30 (30) 11 (28.2) 19 (31.1) 0.754 Cardiac 18 (22.0) 7 (17.9) 11 (18.0) 0.991 Cerebrovascular 3 (3.0) 0 (0) 3 (4.9) 0.279 Peripheral vascular 1 (1.0) 1 (2.6) 0 (0) 0.390 Sudden death 8 (8.0) 3 (7.7) 5 (8.2) 0.102 Infection 27 (27) 12 (30.8) 15 (24.6) 0.497 Peritonitis 3 (3) 0 (0) 3 (4.9) 0.421 Non-peritonitis infections 24 (24.0) 12 (30.8) 12 (19.7) 0.205 Cancer 12 (12) 3 (7.7) 9 (14.8) 0.457 Gastrointestinal hemorrhage 6 (6.0) 1 (2.6) 5 (8.2) 0.400 Others 11 (11.0) 4 (10.3) 7 (11.5) 0.849 Unknown 14 (14.0) 4 (10.3) 10 (16.4) 0.371 Causes of switch to HD [n (%)] n = 16 n = 3 n = 13 Peritonitis 7 (43.8) 2 (66.7) 5 (38.5) 0.550 Catheter complications 2 (12.5) 0 (0) 2 (15.4) 0.546 Inadequate dialysis 0 (0) 0 (0) 0 (0) Others 7 (43.8) 1 (33.3) 6 (46.2) 0.425 Peritonitis Total number of episodes 101 28 73 Peritonitis rate (episode per patient-year) 0.195 0.155 0.216 Peritonitis-free [n (%)] 118 (65.6) 39 (62.9) 79 (66.9) 0.587 Failed treatment for peritonitis * [n (%)] 16 (8.9) 5 (8.1) 11 (9.3) 0.778 Failed treatment for peritonitis* was defined as discontinuation of PD including temporary or permanent transfer to hemodialysis or peritonitis-related deaths; Peritonitis-related deaths included death directly caused by active peritonitis or within 4 weeks of a peritonitis episode, or any death during hospitalization for peritonitis. Patient Survival And Predictors Of All-cause Mortality As shown in Fig. 2 A, assisted PD patients had comparable patient survival to self-care PD patients (Log-rank X 2 = 1.060, P = 0.303). When using a Cox model for the analysis, advanced age (cs-HR 1.09, 95% CI 1.04–1.14, Table 4 ), comorbid with CVD (cs-HR 1.87, 95% CI 1.23–2.83, Table 4 ), lower hemoglobin (cs-HR 0.99, 95% CI 0.97–0.99, Table 4 ) and low RRF group, compared to high RRF group (cs-HR 1.78, 95% CI 1.18–2.71, Table 4 ) were independent predictors for all-cause mortality. In the Fine–Gray (FG) model, advanced age (sd-HR 1.05, 95% CI 1.01–1.09, Table 4 ), comorbid with CVD (sd-HR 1.59, 95% CI 1.05–2.41, Table 4 ) and low RRF group, compared to high RRF group (sd-HR 1.81, 95% CI 1.21–2.72, Table 4 ) were independent predictors for all-cause mortality. However, for both models, the use of assisted PD was not associated with all-cause mortality. Table 4 Adjusted cs-HRs (Cox model) and sd-HR (Fine and Gray model) for each event Variable Death Peritonitis Transfer to HD cs-HR (95% CI) sd-HR (95% CI) cs-HR (95% CI) sd-HR (95% CI) cs-HR (95% CI) sd-HR (95% CI) Age 1.09 (1.04–1.14) *** 1.05 (1.01–1.09) * 1.05 (0.99–1.11) 1.01 (0.95–1.09) 1.15 (1.02–1.31) * 1.05 (0.89–1.24) Male Gender 1.22 (0.78–1.91) 1.26 (0.80–1.98) 1.16 (0.68–1.99) 1.07 (0.61–1.86) 0.30 (0.07–1.36) 0.39 (0.11–1.34) BMI 0.99 (0.93–1.06) 0.94 (0.89-1.00) 1.07 (0.99–1.16) 1.06 (0.96–1.17) 1.31 (1.11–1.55) ** 1.25 (1.02–1.54) * Diabetes 0.85 (0.55–1.32) 1.06 (0.68–1.64) 0.95 (0.55–1.64) 1.02 (0.59–1.76) 0.35 (0.11–1.10) 1.64 (0.67–4.05) CVD 1.87 (1.23–2.83) * 1.59 (1.05–2.41) * 0.85 (0.48–1.51) 0.62 (0.35–1.11) 1.17 (0.30–4.48) 0.40 (0.09–1.78) Hemoglobin 0.99 (0.97–0.99) * 0.99 (0.98-1.00) 0.99 (0.97-1.00) 0.99 (0.98–1.01) 0.99 (0.96–1.03) 1.00 (0.97–1.03) Albumin 1.00 (0.97–1.03) 0.99 (0.96–1.02) 1.00 (0.96–1.03) 0.99 (0.96–1.02) 1.05 (0.96–1.16) 1.06 (0.97–1.15) RRF group a High RRF group Reference Reference Reference Reference Reference Reference Low RRF group 1.78 (1.18–2.71) ** 1.81 (1.21–2.72) ** 0.70 (0.41–1.21) 1.22 (0.69–2.13) 1.79 (0.43–7.38) 0.43 (0.08–2.20) PD Self-PD Reference Reference Reference Reference Reference Reference Assisted-PD 1.40 (0.88–2.21) 1.08 (0.70–1.65) 1.34 (0.73–2.46) 1.22 (0.69–2.13) 0.20 (0.04–0.76) * 0.40 (0.14–1.15) Abbreviations: cs-HR, cause-specific hazard ratio; sd-HR, subdistribution hazard ratio; CI: confidence interval; BMI: body mass index; CVD: cardiovascular disease; RRF: residual renal function. a RRF group was defined as: High RRF group, Residual Renal Function (RRF) > median; Low RRF group, Residual Renal Function (RRF) < median. *P < 0.05, **P < 0.01, ***P < 0.001. Peritonitis-free Survival And Predictors Of Peritonitis As shown in Fig. 2 B, assisted PD patients had comparable peritonitis-free survival to self-care PD patients (Log-rank X 2 = 0.048, P = 0.827). In both Cox and Fine–Gray (FG) models, there was no association between the use of assisted PD and peritonitis-free survival, and no variables were found to be significantly associated with peritonitis-free survival (P > 0.05). Technique Survival And Predictors Of Technique Failure As shown in Fig. 2 C, assisted PD patients had comparable technique survival to self-care PD patients (Log-rank X 2 = 1.888, P = 0.169). In the multivariable analysis, assisted PD (cs-HR 0.20, 95% CI 0.04–0.76, Table 4 ) was protective against the risk of transfer to HD in the Cox model, while advanced age (cs-HR 1.15, 95% CI 1.02–1.31, Table 4 ) and higher BMI (cs-HR 1.31, 95% CI 1.11–1.55, Table 4 ) were associated with an increased risk of technique failure. However, in the Fine–Gray (FG) model, the use of assisted PD was not associated with technique survival and higher BMI (sd-HR 1.25, 95% CI 1.02–1.54, Table 4 ) could predict technique failure in this population. Discussion The present study compared the outcomes between assisted PD patients and self-care PD patients aged 70 or older to investigate the safety and effectiveness of assisted PD in older patients. The results showed that in our cohort, assisted PD patients had a comparable patient survival and peritonitis-free survival to self-care PD patients. Moreover, assisted PD might protect older patients incapable of self-care from technique failure. The demographic and clinical characteristics of the study cohort varied between the assisted group and self-care group. Patients in the assisted PD group were older, more likely to be female, more prevalent in diabetes and cardiovascular disease and carried a heavier burden of comorbid diseases than patients in the self-care PD group. Similar to our study, Boyer et al. showed that patients starting PD with assistance were older than those starting unassisted (70.0 (61.5–78.3) vs 58.7 (43.8–69.2) years) 12 . In another study from France, Lobbedez et al. reported that assisted PD patients were older (74 ± 10.4 vs 52 ± 18.6 years, P < 0.001) and presented more comorbidity (CCI 7 ± 2.5 vs 4.3 ± 2.4, P < 0.05) compared with self-care patients 22 . These findings indicated that patients requiring assistance were often frail and older individuals, with physical disability or cognitive impairment, and had multiple comorbidities. The causes of death were similar in assisted PD group and self-care PD group. It is well documented that cardiovascular disease is the most common cause of deaths in PD patients 23 , 24 . In our study, cardiovascular disease remained the leading cause of death in older PD patients, accounted for up to 30.0% of deaths. However, we found that infection was also a major cause of death, accounted for up to 27.0% of deaths, and the majority of which was due to non-peritonitis infections. Our finding indicated that older PD patients were prone to non-peritonitis infection, this might be a result of a high prevalence of DM, physical disabilities, poor nutrition and immunodeficiency. Therefore, aggressive prevention and treatment of infection is essential for older PD patients. In patient survival, we found that assisted PD patients had similar survival rate with self-care PD patients. In concordance with our study, Smyth et al. reported that there was no difference in patient survival rates between assisted PD patients and self-care PD patients 17 . Querido et al. also found that assisted PD patients had similar survival rate with self-care PD patients 25 . However, in contrast with our results, some studies reported poorer survival rate was observed in assisted PD patients compared to self-care PD patients. Data from the French Peritoneal Dialysis Registry (RDPLF) for 1613 patients older than 75 years of age showed that the survival rate of assisted PD patients, whether assisted by family members or nurses, was lower than patients on self-care PD 26 . The potential causes for the differences in patient survival may be due to the fact that assisted PD in our cohort was provided by one trained dedicated person (e.g., spouse), so the training and daily assistance could be detailed and tailored, and caregivers were more aware of the condition of the patients. However, in the report from the RDPLF, patients were assisted by private community nurses and it is not patient-specific. Besides, several studies have demonstrated that family and social support is associated with improved outcomes in chronic conditions, including end-stage renal disease (ESRD) 27 – 29 . In china, spouses and the younger generations are encouraged to take care of older PD patients. As PD exchanges were performed by their family members or domestic helper at home, patients have a high level of family support, which may be associated with better patient management and improved survival. Another retrospective study of PD included patients over 65 years of age in Taiwan also suggested that older patients on assisted PD had a poorer patient survival rate than self-care PD patients 30 . As the author mentioned in discussion, the possible explanation may be that the assisted-care program for older patients was adopted as early as 1984 in Taiwan, the quality of the training system, which might determine the outcome of assisted PD, was worse than it is now. In consist with other studies, our results showed that advanced age, comorbid with CVD, lower hemoglobin and low RRF group, compared to high RRF group were independent predictors for mortality when using a Cox regression model, while advanced age, comorbid with CVD and low RRF group, compared to high RRF group were independent predictors for mortality in the Fine–Gray (FG) model, which were well-recognized prognostic factors for mortality in older PD patients demonstrated by numerous studies 31 – 35 . The peritonitis rate was 0.155 episode per patient-year in the assisted PD group and 0.216 episode per patient-year in the self-PD group, respectively. In our cohort, peritonitis-free survival was comparable between assisted patients and self-care patients. Similarly, Xu et al. 24 reported that assisted PD patients overall had a similar peritonitis-free time compared with self-care PD patients. Smyth et al. 17 reported that there was no association between the use of assisted PD and peritonitis-free survival. In another report from the RDPLF, Benabed et al. 19 showed that in 3598 diabetic patients between 1 January 2002 and 31 December 2012, nurse-assisted PD patients had a lower risk of peritonitis compared with self-care PD patients while family-assisted PD had no protective effect against peritoneal infection. Verger et al. reported that nurse assistance was associated with a higher risk of peritonitis in APD patients, however, when home visits were made regularly by nurses from the PD center, assisted PD was not associated with a higher risk of peritoneal infection 18 . Taken together, these results demonstrated that the use of assisted PD was not associated with peritonitis-free survival. With regard to technique survival, a significant technique survival benefit was demonstrated in assisted patients compared to self-care patients in the Cox model, but the association lost its statistical significance in the Fine–Gray (FG) model. Consistent with our results, report from the RDPLF which analyzed 9822 incident patients starting PD between January 2002 and December 2010 suggested that assisted patients had a lower risk for transfer to HD compared with self-care patients 36 . Querido et al. also found that technique survival was better in assisted PD patients compared with self-care patients 25 . As older patients who engaged independently in PD usually suffer from poor physical strength, cognitive dysfunction, vision impairment and deafness, which are all conditions that may affect the ideal operation for PD, we suggested that for some frail older patients unable to perform ideal self-dialysis, proper assistance should be provided to reduce the risk of PD technique failure, thereby prolonging the duration of PD. Besides, in concordance with previous studies, higher BMI was associated with increased risk of technique failure either in the Cox or in the FG model, and advanced age could predict technique failure in the Cox model, which were independent predictors of technique failure reported by several previous studies 32 , 37 . Our study also has several limitations. First, it was a retrospective design. Second, our study was a single-centered study. Third, we did not collect the data regarding the quality of life (QoL) in our study, which is an important outcome measure in older patients. From the perspective of gaining high-quality evidence, better designed studies, such as prospective studies with larger sample sizes and multi-center participation, is clearly warranted. In conclusion, our results showed that in a cohort of patients aged 70 or older, assisted PD patients had comparable patient survival and peritonitis-free survival to self-care PD patients. Moreover, assisted PD might protect older patients incapable of self-care from technique failure. Therefore, we suggested that poor self-care ability alone should not be used as a barrier to PD treatment and assisted PD could be a safe and effective modality of RRT for older patients incapable of self-care. Abbreviations ESRD end-stage renal disease; PD:peritoneal dialysis; HD:hemodialysis; DM:diabetes mellitus; CVD:cardiovascular disease; PCI:percutaneous coronary intervention; CABG:coronary artery bypass grafting; BMI:body mass index; iPTH:intact parathyroid hormone; Hs-CRP:high-sensitivity C reaction protein; eGFR:estimated glomerular filtration rate; corrected calcium:total calcium (corrected by albumin); PET:peritoneal equilibration test; Kt/Vurea:urea kinetics; CrCl:creatinine clearance; RRF:residual renal function; nPCR:normalized protein catabolic rate; D/Pcr:peritoneal transport characteristics); cs-HR:cause-specific hazard ratio; sd-HR:subdistribution hazard ratio; CI:confidence interval. Declarations Acknowledgements We thank all of the doctors and nurses at the Nephrology Department of Renji Hospital in Shanghai, China for their work. Author Contributions SQ participated in the design of the study, analysis of data and draft the manuscript. YH and LZ participated in clinical data collection. YZ and YJ helped to perform the statistical analysis. NZ guided and supported this study. FW conceived of the study, and participated in its design and coordination and helped to draft the manuscript. Funding This work was supported by the National Basic Research Program of China (grant no. 81370864, 81670691) and Shanghai Municipal Education Commission-Gaofeng Clinical Medicine (grant no. 20152211). Availability of data and materials The datasets analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate All procedures performed in studies were in accordance with the ethical standards of Renji Hospital on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000.The study was approved by the Human Research Ethics Committee of Renji Hospital, Shanghai Jiao Tong University School of Medicine. The informed consent was exempted as a retrospective study by the Human Research Ethics Committee of Renji Hospital, Shanghai Jiao Tong University School of Medicine. Consent for publication Not applicable. Competing interests The authors have no conflicts of interest to declare. References Liyanage T, Ninomiya T, Jha V, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. The Lancet 2015;385:1975–1982. Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. The Lancet 2012;379:815–822. Brown EA, Johansson L, Farrington K, et al. Broadening Options for Long-term Dialysis in the Elderly (BOLDE): differences in quality of life on peritoneal dialysis compared to haemodialysis for older patients. Nephrol Dial Transplant 2010;25:3755–3763. Couchoud C, Moranne O, Frimat L, et al. Associations between comorbidities, treatment choice and outcome in the elderly with end-stage renal disease. Nephrol Dial Transplant 2007;22:3246–3254. Iyasere OU, Brown EA, Johansson L, et al. Quality of Life and Physical Function in Older Patients on Dialysis: A Comparison of Assisted Peritoneal Dialysis with Hemodialysis. Clin J Am Soc Nephrol 2016;11:423–430. Lamping DL, Constantinovici N, Roderick P, et al. Clinical outcomes, quality of life, and costs in the North Thames Dialysis Study of elderly people on dialysis: a prospective cohort study. The Lancet 2000;356:1543–1550. Sinnakirouchenan R, Holley JL. Peritoneal dialysis versus hemodialysis: risks, benefits, and access issues. Adv Chronic Kidney Dis 2011;18:428–432. Juergensen E, Wuerth D, Finkelstein SH, et al. Hemodialysis and peritoneal dialysis: patients' assessment of their satisfaction with therapy and the impact of the therapy on their lives. Clin J Am Soc Nephrol 2006;1:1191–1196. Hurst H, Figueiredo AE. The Needs of Older Patients for Peritoneal Dialysis: Training and Support at Home. Perit Dial Int 2015;35:625–629. Brown EA, Johansson L. Epidemiology and management of end-stage renal disease in the elderly. Nat Rev Nephrol 2011;7:591–598. Covic A, Bammens B, Lobbedez T, et al. Educating end-stage renal disease patients on dialysis modality selection: clinical advice from the European Renal Best Practice (ERBP) Advisory Board. Nephrol Dial Transplant 2010;25:1757–1759. Boyer A, Solis-Trapala I, Tabinor M, et al. Impact of the implementation of an assisted peritoneal dialysis service on peritoneal dialysis initiation. Nephrol Dial Transplant 2020; 35:1595–1601. Oliver MJ, Quinn RR, Richardson EP, et al. Home care assistance and the utilization of peritoneal dialysis. Kidney Int 2007;71:673–678. Giuliani A, Karopadi AN, Prieto-Velasco M, et al. Worldwide Experiences with Assisted Peritoneal Dialysis. Perit Dial Int 2017;37:503–508. Hofmeister M, Klarenbach S, Soril L, et al. A Systematic Review and Jurisdictional Scan of the Evidence Characterizing and Evaluating Assisted Peritoneal Dialysis Models. Clin J Am Soc Nephrol 2020;15:511–520. Fang W, Ni Z, Qian J. Key Factors for a High-Quality Peritoneal Dialysis Program — the Role of the PD Team and Continuous Quality Improvement. Perit Dial Int 2014; 34(suppl 2):35–42. Smyth A, McCann E, Redahan L, et al. Peritoneal dialysis in an ageing population: a 10-year experience. Int Urol Nephrol 2012;44:283–293. Verger C, Duman M, Durand PY, et al. Influence of autonomy and type of home assistance on the prevention of peritonitis in assisted automated peritoneal dialysis patients. An analysis of data from the French Language Peritoneal Dialysis Registry. Nephrol Dial Transplant 2007;22:1218–1223. Benabed A, Bechade C, Ficheux M, et al. Effect of assistance on peritonitis risk in diabetic patients treated by peritoneal dialysis: report from the French Language Peritoneal Dialysis Registry. Nephrol Dial Transplant 2016;31:656–662. Liakopoulos V, Nikitidou O, Kalathas T, et al. Peritoneal dialysis-related infections recommendations: 2016 update. What is new? Int Urol Nephrol 2017;49:2177–2184. Noordzij M, Leffondre K, van Stralen KJ, et al. When do we need competing risks methods for survival analysis in nephrology? Nephrol Dial Transplant 2013;28:2670–2677. Lobbedez T, Moldovan R, Lecame M, et al. Assisted Peritoneal Dialysis. Experience in a French Renal Department. Perit Dial Int 2006;26:671–676. Fang W, Qian J, Lin A, et al. Comparison of peritoneal dialysis practice patterns and outcomes between a Canadian and a Chinese centre. Nephrol Dial Transplant 2008;23:4021–4028. Xu R, Zhuo M, Yang Z, et al. Experiences with assisted peritoneal dialysis in China. Perit Dial Int 2012;32:94–101. Querido S, Branco PQ, Costa E, et al. Results in Assisted Peritoneal Dialysis: A Ten-Year Experience. Int J Nephrol 2015;2015:712539. Castrale C, Evans D, Verger C, et al. Peritoneal dialysis in elderly patients: report from the French Peritoneal Dialysis Registry (RDPLF). Nephrol Dial Transplant 2010;25:255–262. Holder B. Family Support and Survival Among African-American End-Stage Renal Disease Patients. Advances in Renal Replacement Therapy 1997;4:13–21. Rosland AM, Heisler M, Piette JD. The impact of family behaviors and communication patterns on chronic illness outcomes: a systematic review. J Behav Med 2012;35:221–239. Mercado FJ, Vargas PN. Disease and the family: differences in metabolic control of diabetes mellitus between men and women. Women Health 1989;15:111–121. Cheng CH, Shu KH, Chuang YW, et al. Clinical outcome of elderly peritoneal dialysis patients with assisted care in a single medical centre: a 25 year experience. Nephrology (Carlton) 2013;18:468–473. Bargman JM, Thorpe KE, Churchill DN, et al. Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA study. J Am Soc Nephrol 2001;12:2158–2162. Chidambaram M, Bargman JM, Quinn RR, et al. Patient and physician predictors of peritoneal dialysis technique failure: a population based, retrospective cohort study. Perit Dial Int 2011;31:565–573. Genestier S, Meyer N, Chantrel F, et al. Prognostic survival factors in elderly renal failure patients treated with peritoneal dialysis: a nine-year retrospective study. Perit Dial Int 2010;30:218–226. Hung CC, Chang CT, Lee CC, et al. Prognostic predictors of technique and patient survival in elderly Southeast Asian patients undergoing continuous ambulatory peritoneal dialysis. Int J Clin Pract 2009;63:254–260. Termorshuizen F, Korevaar JC, Dekker FW, et al. The relative importance of residual renal function compared with peritoneal clearance for patient survival and quality of life: an analysis of the netherlands cooperative study on the adequacy of dialysis (Necosad)-2. American Journal of Kidney Diseases 2003;41:1293–1302. Lobbedez T, Verger C, Ryckelynck JP, et al. Is assisted peritoneal dialysis associated with technique survival when competing events are considered? Clin J Am Soc Nephrol 2012;7:612–618. Beddhu S, Zeidel ML, Saul M, et al. The effects of comorbid conditions on the outcomes of patients undergoing peritoneal dialysis. Am J Med 2002;112:696–701. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-154229","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":9987802,"identity":"792109ff-3fbf-4c3a-93a9-86b114a623d5","order_by":0,"name":"Qianhui Song","email":"","orcid":"","institution":"Renji Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Qianhui","middleName":"","lastName":"Song","suffix":""},{"id":9987803,"identity":"301bcc7a-a0e3-4cb5-881d-e6642d9da96a","order_by":1,"name":"Hao Yan","email":"","orcid":"","institution":"Renji Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hao","middleName":"","lastName":"Yan","suffix":""},{"id":9987804,"identity":"d7629e99-8357-4b32-bf03-a722888d3686","order_by":2,"name":"Zanzhe Yu","email":"","orcid":"","institution":"Renji Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zanzhe","middleName":"","lastName":"Yu","suffix":""},{"id":9987805,"identity":"1a56c6ff-0339-4a6d-ac82-4558b07364c6","order_by":3,"name":"Zhenyuan Li","email":"","orcid":"","institution":"Renji Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhenyuan","middleName":"","lastName":"Li","suffix":""},{"id":9987806,"identity":"8314d77e-20d9-4ebf-896b-1ef8f6459471","order_by":4,"name":"Jiangzi Yuan","email":"","orcid":"","institution":"Renji Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jiangzi","middleName":"","lastName":"Yuan","suffix":""},{"id":9987807,"identity":"013185fb-b67a-40c6-b309-ced5c00f0265","order_by":5,"name":"Zhaohui Ni","email":"","orcid":"","institution":"Renji Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhaohui","middleName":"","lastName":"Ni","suffix":""},{"id":9987808,"identity":"e1043903-ccae-4664-a9e2-3ed6fdfac096","order_by":6,"name":"Wei Fang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3ElEQVRIiWNgGAWjYBAC9gYwJQFEzAcOfKggQgvPAbgWtsSDM84QrwWki8f4MG8LMVrYzx5+zVNhwSA/u+fDAd4GBnl+sQMEtPDkpVnznJFgMLhzdsMByR0MhjNnJ+DXYs+QY2ac2wbUIpG74YDhGYYEg9sEtPDwvwFq+SfBID8j58GBxDZitEjkGD/ObQCG2I0chgMHidPyxoz5zzGgw26kGRxsOCNB2C88/DnGH2fU1AEdlvz4858KG3l+aQJagIAN6CqG+gYIR4KgchBg/kCUslEwCkbBKBi5AACV3UP3MGQ5XwAAAABJRU5ErkJggg==","orcid":"","institution":"Renji Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Fang","suffix":""}],"badges":[],"createdAt":"2021-01-24 07:44:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-154229/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-154229/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":5623806,"identity":"7f9d6a9a-7286-4d71-bb59-25b828a38f9a","added_by":"auto","created_at":"2021-02-04 15:27:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1369206,"visible":true,"origin":"","legend":"Patient enrollment and follow-up. Abbreviations: PD peritoneal dialysis; HD hemodialysis.","description":"","filename":"OnlineFigure1.png","url":"https://assets-eu.researchsquare.com/files/rs-154229/v1/43a3bafabf23d109f3a4fd2f.png"},{"id":5623807,"identity":"0dffefda-a1f4-44fb-8547-fdb2ca7b7e69","added_by":"auto","created_at":"2021-02-04 15:27:20","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":297536,"visible":true,"origin":"","legend":"Kaplan-Meier curves by assistance for patient survival (A), peritonitis-free survival (B) and technique survival (C).","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-154229/v1/14a185c8541a161d0b3692ca.jpg"},{"id":15670791,"identity":"07160d23-c7cb-402d-a4c8-f8d524aecae7","added_by":"auto","created_at":"2021-11-18 14:01:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":690701,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-154229/v1/63be7f2c-5c30-466a-8666-e1805394d116.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e\u003cem\u003eComparison of Survival Between Assisted Peritoneal Dialysis and Self-Care Peritoneal Dialysis Patients Aged 70 or Older\u003c/em\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith the aging of the general population, the number of older individuals developing end-stage renal disease (ESRD) continues to rise worldwide, accompanied by a much greater demand for renal replacement therapy (RRT) among the older \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. There was no common consensus to deliver either HD or PD to the older ESRD patients, and several studies suggested comparable or better outcomes with PD among older patients \u003csup\u003e\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Compared with in-center hemodialysis, peritoneal dialysis offers many potential benefits to older patients, such as less intervention in lifestyle, no need for vascular access, fewer hemodynamic variations and cost-effective, etc. \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e When life expectancy is perceived to be short, quality of life (QoL) may be the priority for older patients, especially the \u0026ldquo;old older\u0026rdquo;. PD has also been shown to be associated with better quality of life (QoL) and higher satisfaction with treatment \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. However, barriers to self-care PD including multimorbidity, physical disabilities and psychosocial problems often emerged with increasing age \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Assisted PD is defined as PD treatment performed at the patient\u0026rsquo;s home and with the assistance of a family member, a partner, a community nurse or a healthcare technician \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. As a feasible option for patients who cannot perform their own PD exchanges, assisted PD have been developed in many countries with the aim of overcoming barriers in older and non-self-sufficient patients, and some studies suggested that the use of assisted PD could increase the utilization of PD patients among older \u003csup\u003e\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. However, whether assisted PD achieved similar outcomes to self-care peritoneal dialysis still remained controversial \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Therefore, we conducted the present study to investigate the outcomes of assisted PD in ageing patients, by comparing patients undergoing assisted PD with those on self-care PD in a cohort of older patients.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003e\u003cstrong\u003ePatients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn our study, the cut-off for the definition of an \u0026lsquo;older\u0026rsquo; individual was 70 years of age. All incident patients aged 70 or older who started on PD between 1 January 2009 and 31 December 2018 at Renji Hospital, Shanghai Jiao Tong University School of Medicine, China, were screened for eligibility. Patients had history of maintenance HD/transplantation, withdrew from PD within 3 months or with incomplete data were excluded from the study. All enrolled patients were dialyzed using lactate-buffered glucose-based PD solutions (Dianeal\u0026reg;, Baxter) with twin-bag system. Patients and their caregivers had received standard training after catheterization by PD dedicated nurses \u003csup\u003e16\u003c/sup\u003e. The study was approved by the Human Research Ethics Committee of Renji Hospital, Shanghai Jiao Tong University School of Medicine. All individual information was securely protected and was made available to only the investigators.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDemographic and laboratory data \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe demographic characteristics collected at baseline included age, gender, height, weight, underlying cause of ESRD and comorbid condition status such as diabetes mellitus (DM) and cardiovascular disease (CVD). Hypertension and diabetes were defined either as a comorbid disease or as the etiology of ESRD. CVD was defined as a previous history of any following condition: acute coronary syndrome, heart failure, cerebral infarction or hemorrhage, coronary artery atherosclerosis confirmed by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) therapy. The Charlson comorbidity index was adopted to reflect the burden of comorbid conditions. Body mass index (BMI) was calculated as the weight (kg) divided by the square of height in meters (BMI =weight [kg]/ height [m2]).\u003c/p\u003e\n\u003cp\u003eBaseline laboratory parameters included hemoglobin, serum albumin, creatinine, urea nitrogen, uric acid, sodium, potassium, corrected calcium, phosphate, intact parathyroid hormone (iPTH), total cholesterol, total triglycerides, high-sensitivity C reaction protein (hs-CRP), estimated glomerular filtration rate (eGFR) (mL/min/m2) and fasting blood glucose were collected. The corrected calcium (mmo1/L) = total calcium (mmol/L) + (40- albumin) \u0026times; 0.025 (mmol/L).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSmall solute clearance and peritoneal transport characteristics \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients were evaluated small solute clearance and performed a standard peritoneal equilibration test (PET) 1-3 months after PD initiation. Small solute clearance was assessed by 24-h dialysate and urine collection, with the calculation of total weekly Kt/V and weekly CrCl normalized to 1.73m2 body surface area \u003csup\u003e17\u003c/sup\u003e. Residual renal function (RRF) was calculated as an average of 24-h urine urea and creatinine clearance \u003csup\u003e18\u003c/sup\u003e. Normalized protein catabolic rate (nPCR) was calculated by the methods described by Randerson, Chapman, and Farrell and normalized to standard body weight (total body water/0.58) \u003csup\u003e19\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient follow up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe enrolled patients were divided into assisted PD group (PD exchanges performed by a family member or a domestic helper) and self-care PD group according to the independence of bag exchange, and prospectively followed up until death, transfer to permanent hemodialysis, recovery of renal function, transfer to other centers, lost to follow-up or to the end of study (December 31st, 2019). All deaths, switches to HD and peritonitis episodes during the study period were carefully tracked and recorded. Detailed causes of death, switches to HD and outcome of peritonitis during PD were also collected. Causes of death were grouped in broad categories as follows: cardiovascular, including cardiac, cerebrovascular, peripheral vascular and sudden death; infection, including peritonitis and non-peritonitis infections; cancer; gastrointestinal hemorrhage; other and unknown causes. Causes of switch to HD were grouped into peritonitis; catheter complications; inadequate dialysis and other causes. Peritonitis was diagnosed and managed in accordance with guidelines of the International Society for Peritoneal Dialysis \u003csup\u003e20\u003c/sup\u003e, and peritonitis rate was calculated as number of peritonitis episodes per patient-year at risk.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome measures \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOutcome measures in our study included patient survival, peritonitis-free survival and technique survival. In patient and peritonitis-free survival analysis, the endpoint was death and first episode of peritonitis, respectively. In technique survival analysis, the endpoint was permanent transfer from PD to HD. For both patient and peritonitis-free survival analysis, the censored events were transfer to permanent hemodialysis, recovery of renal function, loss to follow-up, transfer to other dialysis centers, or to the end of study (December 31st, 2019). In technique survival analysis, the endpoint was permanent transfer from PD to HD, and death was regarded as censored event.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistics analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Kolmogorov\u0026ndash;Smirnov test was used to measure data normality. Parametric data were presented as mean \u0026plusmn; standard deviation. Nonparametric data were described by the median value (first and third quartile). Categorical variables were presented by frequencies and percentages and were compared using chi-square tests. Normally distributed continuous variables and abnormally distributed continuous variables were compared using the independent sample t-tests and Mann-Whitney test, respectively. Kaplan-Meier and log-rank test methods were used to estimate and compare survival curves for each event of interest (death, peritonitis and transfer to HD) by comparing assisted PD group with self-care PD group. Considering the presence of competing events in this study, for multivariate analysis, risk factors for all-cause mortality, peritonitis and technique failure were evaluated by both cause-specific hazards and subdistribution hazards models\u003csup\u003e 21\u003c/sup\u003e. When the event of interest was peritonitis, transfer to HD, renal transplantation, death and transfer to other centers were coded as competing events only when occurring before the first peritoneal infection. When the event of interest was death, the competing events included transfer to HD, renal transplantation and transfer to other centers. When the event of interest was technique failure, the competing events included death, renal transplantation and transfer to other centers.\u003c/p\u003e\n\u003cp\u003eData analysis was carried out using the SPSS software package (version 22.0: SPSS, Chicago, IL, USA) and R 3.6.1 (R Foundation for Statistical Computing, Vienna, Austria; the \u0026lsquo;cmprsk\u0026rsquo; library was used to fit the Fine and Gray regression models). All probabilities were two-tailed, and a p\u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy participants\u003c/h2\u003e\n\u003cp\u003eA total of 180 patients were included in present study. Patient enrollment and follow-up were presented in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. Patient characteristics were summarized in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. Among the 180 patients, 62 needed assistance in performing bag exchanges (\u0026ldquo;assisted PD group\u0026rdquo;), and the remaining 118 patients were in the self-care PD group. Patients in the assisted PD group were older (80.7 (76.9\u0026ndash;84.0) vs 75.6 (72.5\u0026ndash;79.2) years, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), less likely to be male (48.4% vs 64.4%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), more prevalent in diabetes (48.4% vs 33.1%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and CVD(46.8% vs 29.7%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with a higher Charlson score (7.0 (6.0\u0026ndash;8.0) vs 6.0 (5.0\u0026ndash;7.0), P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) than those in the self-care PD group, and other demographic and laboratory data were similar between the two groups.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDemographic and laboratory data of the study patients\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAll PD patients\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;180)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAssisted PD group\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eself-care PD group\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;118)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge (years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e77.5 (77.2\u0026ndash;81.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80.7 (76.9\u0026ndash;84.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75.6 (72.5\u0026ndash;79.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGender (male) [n (%)]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e106 (58.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30 (48.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e76 (64.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.038\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e22.6 (20.4\u0026ndash;24.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.9 (20.3\u0026ndash;25.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e23.1 (20.4\u0026ndash;24.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.606\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCharlson\u0026rsquo;s comorbidity index\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6.0 (6.0\u0026ndash;7.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.0 (6.0\u0026ndash;8.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6.0 (5.0\u0026ndash;7.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrimary renal disease [n (%)]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChronic glomerulonephritis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e46 (25.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17 (27.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e29 (24.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.678\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDiabetic nephropathy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e38 (21.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16 (25.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e22 (18.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.263\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHypertension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11 (6.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (4.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8 (6.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.850\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePolycystic kidney disease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2 (1.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2 (1.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.546\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOthers\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20 (11.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 (9.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14 (11.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.657\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUnknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e63 (35.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20 (32.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e43 (36.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.576\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eComorbidity [n (%)]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDiabetes mellitus\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e69 (38.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30 (48.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e39 (33.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.044\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHypertension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e157 (87.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56 (90.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e101 (85.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.366\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCardiovascular disease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e64 (35.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29 (46.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35 (29.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.023\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eothers\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e41 (22.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16 (25.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e25 (21.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.482\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBaseline Laboratory results*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHemoglobin (g/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e86.7\u0026thinsp;\u0026plusmn;\u0026thinsp;16.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e83.9\u0026thinsp;\u0026plusmn;\u0026thinsp;15.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e88.2\u0026thinsp;\u0026plusmn;\u0026thinsp;17.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.110\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAlbumin (g/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e33.1 (29.1\u0026ndash;36.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.1 (28.8\u0026ndash;36.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e32.9 (29.9\u0026ndash;36.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.998\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCreatinine (mmol/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e663.0 (527.9\u0026ndash;789.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e628.5 (486.8-791.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e674.3 (555.2-796.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.231\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBlood urea nitrogen (mmol/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26.5 (21.0-32.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.6 (21.2\u0026ndash;33.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26.4 (21.0-31.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.405\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUric acid (mmol/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e487.5\u0026thinsp;\u0026plusmn;\u0026thinsp;132.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e480.4\u0026thinsp;\u0026plusmn;\u0026thinsp;130.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e491.2\u0026thinsp;\u0026plusmn;\u0026thinsp;133.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.606\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEstimated glomerular filtration rate (eGFR) (mL/min/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.7 (4.5\u0026ndash;7.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.4 (4.4\u0026ndash;7.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.7 (4.5-7.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.686\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSodium (mmol/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e138.1 (136.0-142.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e138.4 (137.0-141.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e138.1 (136.0-142.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.175\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePotassium (mmol/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.590\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal cholesterol (mmol/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.5 (3.8\u0026ndash;5.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.7 (3.7\u0026ndash;5.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.5 (3.9\u0026ndash;5.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.395\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal triglycerides (mmol/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.3 (1.0-1.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.2 (0.9\u0026ndash;1.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.4 (1.0-1.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.154\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCorrected calcium (mmol/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.1 (2.0-2.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.2 (2.0-2.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.1 (2.0-2.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.972\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePhosphate (mmol/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.8 (1.5\u0026ndash;2.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.8 (1.4\u0026ndash;2.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.8 (1.5-2.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.784\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIntact parathyroid hormone (iPTH) (pg/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e275.2 (160.5\u0026ndash;423.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e264.0 (171.2-410.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e285.0 (137.0-424.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.938\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHs-CRP (mg/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.5 (1.3\u0026ndash;13.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.8 (1.5\u0026ndash;13.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.0 (1.2\u0026ndash;13.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.654\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFasting blood glucose (mmol/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.0 (4.4\u0026ndash;5.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.9 (4.5\u0026ndash;6.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.4 (4.4\u0026ndash;5.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.537\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e\u003cstrong\u003eValues expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, median (25th \u0026ndash; 75th percentile), or absolute numbers with percentages [n (%)]\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e: BMI: body mass index, Hs-CRP: high-sensitivity C reaction protein, Corrected calcium: total calcium (corrected by albumin), Kt/Vurea: urea kinetics; CrCl: creatinine clearance; RRF: residual renal function; nPCR: normalized protein catabolic rate; D/Pcr: peritoneal transport characteristics\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003eBaseline Laboratory results* was evaluated at PD initiation (within one week before PD catheterization)\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe indices of small solute clearance, RRF, nPCR and peritoneal transport characteristics (D/Pcr) were shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e and there was no difference between the two groups.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSmall solute clearance and peritoneal transport characteristics\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAll PD patients\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;180)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAssisted PD group\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eself-care PD group\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;118)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSmall solute clearance\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal Kt/V urea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.08 (1.74\u0026ndash;2.43)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.10 (1.78\u0026ndash;2.50)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.07 (1.70\u0026ndash;2.41)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.460\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal CrCl (L/week/1.73m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e68.9 (55.9\u0026ndash;87.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e68.8 (54.0-92.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e68.9 (55.9\u0026ndash;86.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.744\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRRF (ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.09 (1.67\u0026ndash;5.04)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.03 (1.62\u0026ndash;5.24)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.05 (1.64\u0026ndash;5.09)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.931\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003enPCR (g/kg/day)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.82 (0.71\u0026ndash;0.96)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.82 (0.72\u0026ndash;0.95)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.82 (0.70\u0026ndash;0.97)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.930\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eD/Pcr\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.65 (0.56\u0026ndash;0.75)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.66 (0.56\u0026ndash;0.71)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.64 (0.57\u0026ndash;0.75)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.994\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e\u003cstrong\u003eValues expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, median (25th \u0026ndash; 75th percentile), or absolute numbers with percentages [n (%)]\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e: Kt/Vurea: urea kinetics; CrCl: creatinine clearance; RRF: residual renal function; nPCR: normalized protein catabolic rate; D/Pcr: peritoneal transport characteristics\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003ch2\u003ePatient Outcomes\u003c/h2\u003e\n\u003cp\u003ePatient outcomes were summarized in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. The median follow-up was 32.5 months (inter-quartile range, 20.7\u0026ndash;43.7 months) for the assisted PD group and 33 months (inter-quartile range, 12.9\u0026ndash;49.7 months) for the self-care PD group. By the end of the study, 100 (55.6%) patients died, 16 (8.9%) patients switched to HD, 6 (3.3%) patients were transferred to other centers, 1 (0.6%) patient was lost to follow-up, 1 (0.6%) patient was dialysis-independent and 54 (30.0%) patients were still on PD. The causes of death were similar in two groups and the leading cause of death was cardiovascular disease (30.0%), followed by infection (27.0%), unknown causes (14.0%), cancer (12.0%), other causes (11.0%) and gastrointestinal hemorrhage (6.0%). During the study period, a total of 101 episodes of peritonitis were recorded. The peritonitis rate was 0.155 episode per patient-year in the assisted PD group and 0.216 episode per patient-year in the self-care PD group, respectively. By the end of the study, a total of 16 patients transferred to HD. The reasons for transferring to HD were similar in two groups and peritonitis was responsible for 7/16 (44%) of transferring to HD.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eOutcomes of the patients\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAll PD patients\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAssisted PD group\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eself-care PD group\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFollow-up (months)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32.5 (15.7\u0026ndash;42.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32.5 (20.7\u0026ndash;43.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e33.0 (12.9\u0026ndash;49.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOutcomes [n (%)]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003en\u0026thinsp;=\u0026thinsp;180\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003en\u0026thinsp;=\u0026thinsp;62\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003en\u0026thinsp;=\u0026thinsp;118\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDeath\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100 (55.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39 (62.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e61 (51.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.150\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTransfer to HD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16 (8.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (4.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e13 (11.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.166\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTransfer to other centers\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 (3.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e6 (5.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.095\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRecovery of renal function\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (1.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (1.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDialysis independent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (0.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (1.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLost to follow-up\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (0.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (1.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStill on PD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54 (30.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19 (30.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e35 (29.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.891\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCauses of death [n (%)]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003en\u0026thinsp;=\u0026thinsp;100\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003en\u0026thinsp;=\u0026thinsp;39\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003en\u0026thinsp;=\u0026thinsp;61\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCardiovascular disease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30 (30)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11 (28.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e19 (31.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.754\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCardiac\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18 (22.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (17.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e11 (18.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.991\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCerebrovascular\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (3.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e3 (4.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.279\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePeripheral vascular\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (2.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.390\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSudden death\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (8.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (7.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e5 (8.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.102\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInfection\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27 (27)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 (30.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e15 (24.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.497\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePeritonitis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e3 (4.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.421\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-peritonitis infections\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24 (24.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 (30.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e12 (19.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.205\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCancer\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 (12)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (7.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e9 (14.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.457\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGastrointestinal hemorrhage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 (6.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (2.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e5 (8.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.400\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOthers\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11 (11.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (10.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e7 (11.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.849\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUnknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14 (14.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (10.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e10 (16.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.371\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCauses of switch to HD [n (%)]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003en\u0026thinsp;=\u0026thinsp;16\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003en\u0026thinsp;=\u0026thinsp;3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003en\u0026thinsp;=\u0026thinsp;13\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePeritonitis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (43.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (66.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e5 (38.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.550\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCatheter complications\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (12.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2 (15.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.546\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInadequate dialysis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOthers\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (43.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (33.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e6 (46.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.425\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePeritonitis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal number of episodes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e101\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePeritonitis rate (episode per patient-year)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.195\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.155\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.216\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePeritonitis-free [n (%)]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e118 (65.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39 (62.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e79 (66.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.587\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFailed treatment for peritonitis * [n (%)]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16 (8.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (8.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e11 (9.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.778\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eFailed treatment for peritonitis* was defined as discontinuation of PD including temporary or permanent transfer to hemodialysis or peritonitis-related deaths; Peritonitis-related deaths included death directly caused by active peritonitis or within 4 weeks of a peritonitis episode, or any death during hospitalization for peritonitis.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003ch2\u003ePatient Survival And Predictors Of All-cause Mortality\u003c/h2\u003e\n\u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eA, assisted PD patients had comparable patient survival to self-care PD patients (Log-rank X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.060, P\u0026thinsp;=\u0026thinsp;0.303). When using a Cox model for the analysis, advanced age (cs-HR 1.09, 95% CI 1.04\u0026ndash;1.14, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e), comorbid with CVD (cs-HR 1.87, 95% CI 1.23\u0026ndash;2.83, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e), lower hemoglobin (cs-HR 0.99, 95% CI 0.97\u0026ndash;0.99, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e) and low RRF group, compared to high RRF group (cs-HR 1.78, 95% CI 1.18\u0026ndash;2.71, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e) were independent predictors for all-cause mortality. In the Fine\u0026ndash;Gray (FG) model, advanced age (sd-HR 1.05, 95% CI 1.01\u0026ndash;1.09, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e), comorbid with CVD (sd-HR 1.59, 95% CI 1.05\u0026ndash;2.41, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e) and low RRF group, compared to high RRF group (sd-HR 1.81, 95% CI 1.21\u0026ndash;2.72, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e) were independent predictors for all-cause mortality. However, for both models, the use of assisted PD was not associated with all-cause mortality.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eAdjusted cs-HRs (Cox model) and sd-HR (Fine and Gray model) for each event\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eDeath\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ePeritonitis\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTransfer to HD\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ecs-HR (95% CI)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003esd-HR (95% CI)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ecs-HR (95% CI)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003esd-HR (95% CI)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ecs-HR (95% CI)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003esd-HR (95% CI)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.09 (1.04\u0026ndash;1.14)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.05 (1.01\u0026ndash;1.09)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.05 (0.99\u0026ndash;1.11)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.01 (0.95\u0026ndash;1.09)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.15 (1.02\u0026ndash;1.31)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.05 (0.89\u0026ndash;1.24)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale Gender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.22 (0.78\u0026ndash;1.91)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.26 (0.80\u0026ndash;1.98)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.16 (0.68\u0026ndash;1.99)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.07 (0.61\u0026ndash;1.86)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.30 (0.07\u0026ndash;1.36)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.39 (0.11\u0026ndash;1.34)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBMI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.99 (0.93\u0026ndash;1.06)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.94 (0.89-1.00)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.07 (0.99\u0026ndash;1.16)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.06 (0.96\u0026ndash;1.17)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.31 (1.11\u0026ndash;1.55)\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.25 (1.02\u0026ndash;1.54)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDiabetes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.85 (0.55\u0026ndash;1.32)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.06 (0.68\u0026ndash;1.64)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.95 (0.55\u0026ndash;1.64)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.02 (0.59\u0026ndash;1.76)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.35 (0.11\u0026ndash;1.10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.64 (0.67\u0026ndash;4.05)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCVD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.87 (1.23\u0026ndash;2.83)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.59 (1.05\u0026ndash;2.41)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.85 (0.48\u0026ndash;1.51)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.62 (0.35\u0026ndash;1.11)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.17 (0.30\u0026ndash;4.48)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.40 (0.09\u0026ndash;1.78)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHemoglobin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.99 (0.97\u0026ndash;0.99)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.99 (0.98-1.00)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.99 (0.97-1.00)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.99 (0.98\u0026ndash;1.01)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.99 (0.96\u0026ndash;1.03)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00 (0.97\u0026ndash;1.03)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAlbumin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00 (0.97\u0026ndash;1.03)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.99 (0.96\u0026ndash;1.02)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00 (0.96\u0026ndash;1.03)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.99 (0.96\u0026ndash;1.02)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.05 (0.96\u0026ndash;1.16)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.06 (0.97\u0026ndash;1.15)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRRF group \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHigh RRF group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLow RRF group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.78 (1.18\u0026ndash;2.71)\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.81 (1.21\u0026ndash;2.72)\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.70 (0.41\u0026ndash;1.21)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.22 (0.69\u0026ndash;2.13)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.79 (0.43\u0026ndash;7.38)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.43 (0.08\u0026ndash;2.20)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSelf-PD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAssisted-PD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.40 (0.88\u0026ndash;2.21)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.08 (0.70\u0026ndash;1.65)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.34 (0.73\u0026ndash;2.46)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.22 (0.69\u0026ndash;2.13)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.20 (0.04\u0026ndash;0.76)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.40 (0.14\u0026ndash;1.15)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003eAbbreviations: cs-HR, cause-specific hazard ratio; sd-HR, subdistribution hazard ratio; CI: confidence interval; BMI: body mass index; CVD: cardiovascular disease; RRF: residual renal function.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003e\u003csup\u003ea\u003c/sup\u003e RRF group was defined as: High RRF group, Residual Renal Function (RRF)\u0026thinsp;\u0026gt;\u0026thinsp;median; Low RRF group, Residual Renal Function (RRF)\u0026thinsp;\u0026lt;\u0026thinsp;median.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003e*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **P\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***P\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003ch2\u003ePeritonitis-free Survival And Predictors Of Peritonitis\u003c/h2\u003e\n\u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eB, assisted PD patients had comparable peritonitis-free survival to self-care PD patients (Log-rank X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.048, P\u0026thinsp;=\u0026thinsp;0.827). In both Cox and Fine\u0026ndash;Gray (FG) models, there was no association between the use of assisted PD and peritonitis-free survival, and no variables were found to be significantly associated with peritonitis-free survival (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003ch2\u003eTechnique Survival And Predictors Of Technique Failure\u003c/h2\u003e\n\u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eC, assisted PD patients had comparable technique survival to self-care PD patients (Log-rank X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.888, P\u0026thinsp;=\u0026thinsp;0.169). In the multivariable analysis, assisted PD (cs-HR 0.20, 95% CI 0.04\u0026ndash;0.76, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e) was protective against the risk of transfer to HD in the Cox model, while advanced age (cs-HR 1.15, 95% CI 1.02\u0026ndash;1.31, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e) and higher BMI (cs-HR 1.31, 95% CI 1.11\u0026ndash;1.55, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e) were associated with an increased risk of technique failure. However, in the Fine\u0026ndash;Gray (FG) model, the use of assisted PD was not associated with technique survival and higher BMI (sd-HR 1.25, 95% CI 1.02\u0026ndash;1.54, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e) could predict technique failure in this population.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study compared the outcomes between assisted PD patients and self-care PD patients aged 70 or older to investigate the safety and effectiveness of assisted PD in older patients. The results showed that in our cohort, assisted PD patients had a comparable patient survival and peritonitis-free survival to self-care PD patients. Moreover, assisted PD might protect older patients incapable of self-care from technique failure.\u003c/p\u003e\u003cp\u003eThe demographic and clinical characteristics of the study cohort varied between the assisted group and self-care group. Patients in the assisted PD group were older, more likely to be female, more prevalent in diabetes and cardiovascular disease and carried a heavier burden of comorbid diseases than patients in the self-care PD group. Similar to our study, Boyer et al. showed that patients starting PD with assistance were older than those starting unassisted (70.0 (61.5\u0026ndash;78.3) vs 58.7 (43.8\u0026ndash;69.2) years) \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. In another study from France, Lobbedez et al. reported that assisted PD patients were older (74\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4 vs 52\u0026thinsp;\u0026plusmn;\u0026thinsp;18.6 years, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and presented more comorbidity (CCI 7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 vs 4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) compared with self-care patients \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. These findings indicated that patients requiring assistance were often frail and older individuals, with physical disability or cognitive impairment, and had multiple comorbidities.\u003c/p\u003e\u003cp\u003eThe causes of death were similar in assisted PD group and self-care PD group. It is well documented that cardiovascular disease is the most common cause of deaths in PD patients \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. In our study, cardiovascular disease remained the leading cause of death in older PD patients, accounted for up to 30.0% of deaths. However, we found that infection was also a major cause of death, accounted for up to 27.0% of deaths, and the majority of which was due to non-peritonitis infections. Our finding indicated that older PD patients were prone to non-peritonitis infection, this might be a result of a high prevalence of DM, physical disabilities, poor nutrition and immunodeficiency. Therefore, aggressive prevention and treatment of infection is essential for older PD patients. In patient survival, we found that assisted PD patients had similar survival rate with self-care PD patients. In concordance with our study, Smyth et al. reported that there was no difference in patient survival rates between assisted PD patients and self-care PD patients \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Querido et al. also found that assisted PD patients had similar survival rate with self-care PD patients \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. However, in contrast with our results, some studies reported poorer survival rate was observed in assisted PD patients compared to self-care PD patients. Data from the French Peritoneal Dialysis Registry (RDPLF) for 1613 patients older than 75 years of age showed that the survival rate of assisted PD patients, whether assisted by family members or nurses, was lower than patients on self-care PD \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. The potential causes for the differences in patient survival may be due to the fact that assisted PD in our cohort was provided by one trained dedicated person (e.g., spouse), so the training and daily assistance could be detailed and tailored, and caregivers were more aware of the condition of the patients. However, in the report from the RDPLF, patients were assisted by private community nurses and it is not patient-specific. Besides, several studies have demonstrated that family and social support is associated with improved outcomes in chronic conditions, including end-stage renal disease (ESRD) \u003csup\u003e\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. In china, spouses and the younger generations are encouraged to take care of older PD patients. As PD exchanges were performed by their family members or domestic helper at home, patients have a high level of family support, which may be associated with better patient management and improved survival. Another retrospective study of PD included patients over 65 years of age in Taiwan also suggested that older patients on assisted PD had a poorer patient survival rate than self-care PD patients \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. As the author mentioned in discussion, the possible explanation may be that the assisted-care program for older patients was adopted as early as 1984 in Taiwan, the quality of the training system, which might determine the outcome of assisted PD, was worse than it is now. In consist with other studies, our results showed that advanced age, comorbid with CVD, lower hemoglobin and low RRF group, compared to high RRF group were independent predictors for mortality when using a Cox regression model, while advanced age, comorbid with CVD and low RRF group, compared to high RRF group were independent predictors for mortality in the Fine\u0026ndash;Gray (FG) model, which were well-recognized prognostic factors for mortality in older PD patients demonstrated by numerous studies \u003csup\u003e\u003cspan additionalcitationids=\"CR32 CR33 CR34\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe peritonitis rate was 0.155 episode per patient-year in the assisted PD group and 0.216 episode per patient-year in the self-PD group, respectively. In our cohort, peritonitis-free survival was comparable between assisted patients and self-care patients. Similarly, Xu et al. \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e reported that assisted PD patients overall had a similar peritonitis-free time compared with self-care PD patients. Smyth et al. 17 reported that there was no association between the use of assisted PD and peritonitis-free survival. In another report from the RDPLF, Benabed et al. \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e showed that in 3598 diabetic patients between 1 January 2002 and 31 December 2012, nurse-assisted PD patients had a lower risk of peritonitis compared with self-care PD patients while family-assisted PD had no protective effect against peritoneal infection. Verger et al. reported that nurse assistance was associated with a higher risk of peritonitis in APD patients, however, when home visits were made regularly by nurses from the PD center, assisted PD was not associated with a higher risk of peritoneal infection \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Taken together, these results demonstrated that the use of assisted PD was not associated with peritonitis-free survival.\u003c/p\u003e\u003cp\u003eWith regard to technique survival, a significant technique survival benefit was demonstrated in assisted patients compared to self-care patients in the Cox model, but the association lost its statistical significance in the Fine\u0026ndash;Gray (FG) model. Consistent with our results, report from the RDPLF which analyzed 9822 incident patients starting PD between January 2002 and December 2010 suggested that assisted patients had a lower risk for transfer to HD compared with self-care patients \u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. Querido et al. also found that technique survival was better in assisted PD patients compared with self-care patients \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. As older patients who engaged independently in PD usually suffer from poor physical strength, cognitive dysfunction, vision impairment and deafness, which are all conditions that may affect the ideal operation for PD, we suggested that for some frail older patients unable to perform ideal self-dialysis, proper assistance should be provided to reduce the risk of PD technique failure, thereby prolonging the duration of PD. Besides, in concordance with previous studies, higher BMI was associated with increased risk of technique failure either in the Cox or in the FG model, and advanced age could predict technique failure in the Cox model, which were independent predictors of technique failure reported by several previous studies \u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eOur study also has several limitations. First, it was a retrospective design. Second, our study was a single-centered study. Third, we did not collect the data regarding the quality of life (QoL) in our study, which is an important outcome measure in older patients. From the perspective of gaining high-quality evidence, better designed studies, such as prospective studies with larger sample sizes and multi-center participation, is clearly warranted.\u003c/p\u003e\u003cp\u003e In conclusion, our results showed that in a cohort of patients aged 70 or older, assisted PD patients had comparable patient survival and peritonitis-free survival to self-care PD patients. Moreover, assisted PD might protect older patients incapable of self-care from technique failure. Therefore, we suggested that poor self-care ability alone should not be used as a barrier to PD treatment and assisted PD could be a safe and effective modality of RRT for older patients incapable of self-care.\u003c/p\u003e"},{"header":"Abbreviations","content":" \u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eESRD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eend-stage renal disease; PD:peritoneal dialysis; HD:hemodialysis; DM:diabetes mellitus; CVD:cardiovascular disease; PCI:percutaneous coronary intervention; CABG:coronary artery bypass grafting; BMI:body mass index; iPTH:intact parathyroid hormone; Hs-CRP:high-sensitivity C reaction protein; eGFR:estimated glomerular filtration rate; corrected calcium:total calcium (corrected by albumin); PET:peritoneal equilibration test; Kt/Vurea:urea kinetics; CrCl:creatinine clearance; RRF:residual renal function; nPCR:normalized protein catabolic rate; D/Pcr:peritoneal transport characteristics); cs-HR:cause-specific hazard ratio; sd-HR:subdistribution hazard ratio; CI:confidence interval.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all of the doctors and nurses at the Nephrology Department of Renji Hospital in Shanghai, China for their work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSQ participated in the design of the study, analysis of data and draft the manuscript. YH and LZ participated in clinical data collection. YZ and YJ helped to perform the statistical analysis. NZ guided and supported this study. FW conceived of the study, and participated in its design and coordination and helped to draft the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the National Basic Research Program of China (grant no. 81370864, 81670691) and Shanghai Municipal Education Commission-Gaofeng Clinical Medicine (grant no. 20152211).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies were in accordance with the ethical standards of Renji Hospital on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000.The study was approved by the Human Research Ethics Committee of Renji Hospital, Shanghai Jiao Tong University School of Medicine. The informed consent was exempted as a retrospective study by the Human Research Ethics Committee of Renji Hospital, Shanghai Jiao Tong University School of Medicine.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to declare.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLiyanage T, Ninomiya T, Jha V, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. The Lancet 2015;385:1975\u0026ndash;1982.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. The Lancet 2012;379:815\u0026ndash;822.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrown EA, Johansson L, Farrington K, et al. Broadening Options for Long-term Dialysis in the Elderly (BOLDE): differences in quality of life on peritoneal dialysis compared to haemodialysis for older patients. Nephrol Dial Transplant 2010;25:3755\u0026ndash;3763.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCouchoud C, Moranne O, Frimat L, et al. Associations between comorbidities, treatment choice and outcome in the elderly with end-stage renal disease. Nephrol Dial Transplant 2007;22:3246\u0026ndash;3254.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIyasere OU, Brown EA, Johansson L, et al. Quality of Life and Physical Function in Older Patients on Dialysis: A Comparison of Assisted Peritoneal Dialysis with Hemodialysis. Clin J Am Soc Nephrol 2016;11:423\u0026ndash;430.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLamping DL, Constantinovici N, Roderick P, et al. Clinical outcomes, quality of life, and costs in the North Thames Dialysis Study of elderly people on dialysis: a prospective cohort study. The Lancet 2000;356:1543\u0026ndash;1550.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSinnakirouchenan R, Holley JL. Peritoneal dialysis versus hemodialysis: risks, benefits, and access issues. Adv Chronic Kidney Dis 2011;18:428\u0026ndash;432.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJuergensen E, Wuerth D, Finkelstein SH, et al. Hemodialysis and peritoneal dialysis: patients' assessment of their satisfaction with therapy and the impact of the therapy on their lives. Clin J Am Soc Nephrol 2006;1:1191\u0026ndash;1196.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHurst H, Figueiredo AE. The Needs of Older Patients for Peritoneal Dialysis: Training and Support at Home. Perit Dial Int 2015;35:625\u0026ndash;629.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrown EA, Johansson L. Epidemiology and management of end-stage renal disease in the elderly. Nat Rev Nephrol 2011;7:591\u0026ndash;598.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCovic A, Bammens B, Lobbedez T, et al. Educating end-stage renal disease patients on dialysis modality selection: clinical advice from the European Renal Best Practice (ERBP) Advisory Board. Nephrol Dial Transplant 2010;25:1757\u0026ndash;1759.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBoyer A, Solis-Trapala I, Tabinor M, et al. Impact of the implementation of an assisted peritoneal dialysis service on peritoneal dialysis initiation. Nephrol Dial Transplant 2020; 35:1595\u0026ndash;1601.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOliver MJ, Quinn RR, Richardson EP, et al. Home care assistance and the utilization of peritoneal dialysis. Kidney Int 2007;71:673\u0026ndash;678.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGiuliani A, Karopadi AN, Prieto-Velasco M, et al. Worldwide Experiences with Assisted Peritoneal Dialysis. Perit Dial Int 2017;37:503\u0026ndash;508.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHofmeister M, Klarenbach S, Soril L, et al. A Systematic Review and Jurisdictional Scan of the Evidence Characterizing and Evaluating Assisted Peritoneal Dialysis Models. Clin J Am Soc Nephrol 2020;15:511\u0026ndash;520.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFang W, Ni Z, Qian J. Key Factors for a High-Quality Peritoneal Dialysis Program \u0026mdash; the Role of the PD Team and Continuous Quality Improvement. Perit Dial Int 2014; 34(suppl 2):35\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSmyth A, McCann E, Redahan L, et al. Peritoneal dialysis in an ageing population: a 10-year experience. Int Urol Nephrol 2012;44:283\u0026ndash;293.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVerger C, Duman M, Durand PY, et al. Influence of autonomy and type of home assistance on the prevention of peritonitis in assisted automated peritoneal dialysis patients. An analysis of data from the French Language Peritoneal Dialysis Registry. Nephrol Dial Transplant 2007;22:1218\u0026ndash;1223.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBenabed A, Bechade C, Ficheux M, et al. Effect of assistance on peritonitis risk in diabetic patients treated by peritoneal dialysis: report from the French Language Peritoneal Dialysis Registry. Nephrol Dial Transplant 2016;31:656\u0026ndash;662.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiakopoulos V, Nikitidou O, Kalathas T, et al. Peritoneal dialysis-related infections recommendations: 2016 update. What is new? Int Urol Nephrol 2017;49:2177\u0026ndash;2184.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNoordzij M, Leffondre K, van Stralen KJ, et al. When do we need competing risks methods for survival analysis in nephrology? Nephrol Dial Transplant 2013;28:2670\u0026ndash;2677.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLobbedez T, Moldovan R, Lecame M, et al. Assisted Peritoneal Dialysis. Experience in a French Renal Department. Perit Dial Int 2006;26:671\u0026ndash;676.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFang W, Qian J, Lin A, et al. Comparison of peritoneal dialysis practice patterns and outcomes between a Canadian and a Chinese centre. Nephrol Dial Transplant 2008;23:4021\u0026ndash;4028.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXu R, Zhuo M, Yang Z, et al. Experiences with assisted peritoneal dialysis in China. Perit Dial Int 2012;32:94\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eQuerido S, Branco PQ, Costa E, et al. Results in Assisted Peritoneal Dialysis: A Ten-Year Experience. Int J Nephrol 2015;2015:712539.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCastrale C, Evans D, Verger C, et al. Peritoneal dialysis in elderly patients: report from the French Peritoneal Dialysis Registry (RDPLF). Nephrol Dial Transplant 2010;25:255\u0026ndash;262.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHolder B. Family Support and Survival Among African-American End-Stage Renal Disease Patients. Advances in Renal Replacement Therapy 1997;4:13\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRosland AM, Heisler M, Piette JD. The impact of family behaviors and communication patterns on chronic illness outcomes: a systematic review. J Behav Med 2012;35:221\u0026ndash;239.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMercado FJ, Vargas PN. Disease and the family: differences in metabolic control of diabetes mellitus between men and women. Women Health 1989;15:111\u0026ndash;121.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCheng CH, Shu KH, Chuang YW, et al. Clinical outcome of elderly peritoneal dialysis patients with assisted care in a single medical centre: a 25 year experience. Nephrology (Carlton) 2013;18:468\u0026ndash;473.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBargman JM, Thorpe KE, Churchill DN, et al. Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA study. J Am Soc Nephrol 2001;12:2158\u0026ndash;2162.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChidambaram M, Bargman JM, Quinn RR, et al. Patient and physician predictors of peritoneal dialysis technique failure: a population based, retrospective cohort study. Perit Dial Int 2011;31:565\u0026ndash;573.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGenestier S, Meyer N, Chantrel F, et al. Prognostic survival factors in elderly renal failure patients treated with peritoneal dialysis: a nine-year retrospective study. Perit Dial Int 2010;30:218\u0026ndash;226.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHung CC, Chang CT, Lee CC, et al. Prognostic predictors of technique and patient survival in elderly Southeast Asian patients undergoing continuous ambulatory peritoneal dialysis. Int J Clin Pract 2009;63:254\u0026ndash;260.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTermorshuizen F, Korevaar JC, Dekker FW, et al. The relative importance of residual renal function compared with peritoneal clearance for patient survival and quality of life: an analysis of the netherlands cooperative study on the adequacy of dialysis (Necosad)-2. American Journal of Kidney Diseases 2003;41:1293\u0026ndash;1302.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLobbedez T, Verger C, Ryckelynck JP, et al. Is assisted peritoneal dialysis associated with technique survival when competing events are considered? Clin J Am Soc Nephrol 2012;7:612\u0026ndash;618.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBeddhu S, Zeidel ML, Saul M, et al. The effects of comorbid conditions on the outcomes of patients undergoing peritoneal dialysis. Am J Med 2002;112:696\u0026ndash;701.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Assisted peritoneal dialysis, older adults, patient survival, technique survival, peritonitis-free survival","lastPublishedDoi":"10.21203/rs.3.rs-154229/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-154229/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e\u003cp\u003eAssisted PD is used as an alternative option for the growing group of frail, older ESRD patients unable to perform their own PD. This study was undertaken to investigate the outcomes of assisted PD in older patients by comparing assisted PD patients with self-care PD patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis study included all patients aged 70 or older who started on PD in our hospital from 2009 to 2018. Patients were divided into assisted PD group and self-care PD group according to the independence of bag exchange, and followed up until death, PD cessation or to the end of the study (December 31, 2019). Survival curves were generated using the Kaplan-Meier method and risk factors associated with mortality, peritonitis and technique failure were evaluated using both cause-specific hazards and subdistribution hazards models.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003e180 patients were enrolled, including 106 (58.9%) males with a median age of 77.5 (77.2\u0026ndash;81.2) years. Among the 180 patients, 62 patients (34.4%) were assisted. Patients in the assisted PD group were older, more likely to be female, more prevalent in DM and CVD, with a higher Charlson score than patients in the self-care PD group (P all \u0026lt;\u0026thinsp;0.05). In the multivariable analysis, assisted patients had a comparable patient survival and peritonitis-free survival compared to self-care PD patients either in the Cox or in the FG models. According to a Cox model, the use of assisted PD was associated with a lower risk of technique failure (cs-HR 0.20, 95% CI 0.04\u0026ndash;0.76), but the association lost its statistical significance in the Fine and Gray model.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eNo significant difference in patient survival and peritonitis-free survival were found between the assisted PD patients and self-care PD patients. Moreover, assisted PD might protect older patients incapable of self-care from technique failure. Therefore, we suggested that assisted PD could be a safe and effective RRT modality for older ESRD patients who need assistance.\u003c/p\u003e","manuscriptTitle":"Comparison of Survival Between Assisted Peritoneal Dialysis and Self-Care Peritoneal Dialysis Patients Aged 70 or Older","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-02-04 15:24:18","doi":"10.21203/rs.3.rs-154229/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e1f4c7ed-5a6a-4315-96d2-466d9b72f08b","owner":[],"postedDate":"February 4th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":2217757,"name":"Geriatrics \u0026 Gerontology"}],"tags":[],"updatedAt":"2021-02-04T15:24:19+00:00","versionOfRecord":[],"versionCreatedAt":"2021-02-04 15:24:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-154229","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-154229","identity":"rs-154229","version":["v1"]},"buildId":"ApUGefWb6u5IBVtyqm6d5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}