O55
FRAIL ELDERLY PATIENT OUTCOMES ON DIALYSIS (FEPOD): PART 1 – A
CROSS-SECTIONAL COMPARISON OF ASSISTED PERITONEAL DIALYSIS AND
HAEMODIALYSIS
Brown E.A., Iyasere O, Johansson L, Smee J, Huson L and FEPOD 1 Investigators
Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust;
Renal units SE England and Northern Ireland
INTRODUCTION: Haemodialysis (HD) is the most common dialysis modality for frail older
patients although many tolerate this poorly and have transport problems. Assisted peritoneal
dialysis (aPD) is increasingly available to enable home treatment. There is no data about patient
outcomes on aPD compared to HD. This study has been designed in 2 parts. Part 1 is a crosssectional study obtaining a snapshot view of patient well-being on aPD compared to HD. Part 2
is a prospective longitudinal study determining patient outcomes over 2 years. This report
focuses on the results of Part 1.
PRIMARY OUTCOME: Comparison of quality of life and physical function of prevalent frail
older patients on aPD and HD
METHODS: aPD patients (defined as requiring assistance to perform PD by paid or unpaid
carer) and HD patients (requiring hospital transport) were recruited from 11 centres. All were
≥60 years, on dialysis for ≥3 months and free from hospitalisation for 30 days. The HD eligible
patients were matched to recruited aPD participants by age (±3 years), sex, diabetes status, time
on dialysis (± 2 years), ethnicity and Index of Deprivation. Quality of life assessments were
made using Hospital Anxiety and Depression Scale (HADS), SF-12, Palliative Outcome
Symptom Scale and Illness Intrusiveness Rating Scale. Physical function was assessed by
Barthel score (measure of aids to daily living) and Timed Up and Go.
RESULTS: 54 aPD and 52 matched HD patients were studied. Mean age was 74.1 + 7.5 and
72.7 + 7.8 years respectively; presence of frailty was similar between both modalities (57.4% on
aPD and in 42.3% on HD). Multivariate analyses with p-values derived from a generalised
linear model showed that frailty score was the most influential variable in relation to outcomes:
SF 12 physical p=0.002; SF 12 mental p=0.03; Barthel p<0.0001; Timed Up and Go p<0.0001.
Dialysis modality was the most influential variable in determining the total HADS score (mean
aPD 12.6, HD 9.5, p=0.0472) and symptom score (median aPD 17, HD 13.5, p=0.023). Using a
propensity score derived from age, gender, frailty and comorbidity scores to compare pairs of
participants on aPD and HD, showed that the significantly higher HADS score on aPD (P=0.03)
remained but not the symptom score (P=0.37). Probable depression (HADS >8) was also more
common in the aPD group (p=0.0442).
RELEVANCE: Degree of frailty is the major determinant of quality of life and physical
function. Dialysis modality has a minor role with probably slightly more depression in the aPD
group but this needs confirming in the larger longitudinal study. Both aPD and HD should
therefore be discussed as potential modalities leaving choice to individual patients.