Bulletin de la Dialyse à Domicile

Trends in Assisted Peritoneal Dialysis in France Over 45 Years: Data from the RDPLF Registry

2026-03-08T00:11:32+01:00

Background
Assisted peritoneal dialysis (PD) has played an important role in France by enabling elderly and frail patients to access home dialysis despite limited autonomy, supported by the widespread involvement of home nursing care. The aim of this study is to describe the evolution of assisted PD in France using data from the RDPLF registry.
Methods
Incident PD patients recorded between 1981 and 2025 were analyzed and grouped into consecutive 5-year periods. For each period, we assessed the number of incident patients, the proportion receiving assisted treatment, and mean age, separately for continuous ambulatory PD (CAPD) and automated PD (APD).
Results
A total of 42,000 patients were included. The proportion of assisted CAPD patients increased steadily, peaking at around 72% between 2006 and 2010, before declining to 52% in recent years. In contrast, assisted APD decreased continuously, from approximately 40% in the early 1980s to 12% in 2025.
Discussioon: These trends were not related to patient age but were largely explained by a marked reduction in private nurse assistance. APD, more often used by younger patients, was consistently associated with greater autonomy. Over the last five years, PD incidence declined while the proportion of autonomous patients increased. The decrease in the incidence of PD in France could be linked to a preferential selection of independent patients, due to the reduced availability of private home nurses.
Conclusions
The evolution of assisted PD in France raises important public health concerns. Reduced access to home nursing care may limit access to PD for frail patients and hinder its development. The future of home dialysis depends on striking the right balance between patient autonomy and ongoing professional support.

Use of high doses of intraperitoneal amikacin to preserve the peritoneal catheter during pseudomonas peritonitis

2026-03-08T00:24:02+01:00

This article reports a clinical case illustrating the use of high-dose intraperitoneal amikacin to preserve the peritoneal catheter in a patient with Pseudomonas aeruginosa peritonitis undergoing chronic peritoneal dialysis. Pseudomonas peritonitis is known for its severity, poor response to standard treatments, and high probability of leading to catheter removal, often resulting in a harmful transition to hemodialysis.
The patient, aged 46, with stage V renal failure secondary to HIV-associated nephropathy, had been treated with continuous ambulatory peritoneal dialysis since 2021. After an episode of Pseudomonas peritonitis in 2023, which was successfully treated, he presented in 2024 with a recurrence associated with an infection at the catheter exit site. Despite empirical and then targeted antibiotic therapy in accordance with ISPD recommendations (cephalosporin, gentamicin, then cefepime and ciprofloxacin, then meropenem instead of cefepime), the biological progression remained unfavorable, with persistently high cellularity in the peritoneal fluid.
Given this lack of response, high-dose intraperitoneal amikacin bolusesup to 12 mg/kg) were administered. Each injection was followed by a marked decrease in peritoneal cellularity, although there was an initial rebound requiring repeated administrations. After a third and final lower dose, complete normalization of the dialysis fluid was achieved without removal of the catheter.
No adverse effects, particularly auditory or vestibular, were observed in the short or medium term, although no systematic audiometry was performed at a distance. The authors emphasize the pharmacodynamic interest of intraperitoneal administration, which enables high local concentrations well above the MIC while limiting systemic exposure.
In conclusion, this case suggests that the exceptional use of high intraperitoneal doses of amikacin may represent an effective rescue option in selected patients, when catheter removal is associated with a high risk of morbidity and mortality.

Contributions of connected devices and telemonitoring in home dialysis

2026-03-08T00:29:44+01:00

Home dialysis, including peritoneal dialysis and home hemodialysis, is a treatment option for patients with end-stage renal disease that offers greater independence and improved quality of life. However, its widespread use remains limited by safety concerns, technical complexity, and challenges with remote clinical monitoring.
In this context, the development of connected devices and telemonitoring represents a significant advance. Telemonitoring platforms enable continuous transmission of clinical and technical data from dialysis sessions, promoting a proactive approach to monitoring, early detection of complications, and rapid prescription adjustments. Numerous studies, mainly in automated peritoneal dialysis, have shown improved treatment adherence, reduced hospitalizations, better technical survival, and more recently, a positive impact on mortality. Emerging data also show benefits for manual peritoneal dialysis and home hemodialysis, although the literature remains more limited for the latter modality.
Beyond improving care, the data generated by telemonitoring are a valuable resource for clinical research and the development of data-driven personalized medicine. Despite promising prospects, technological, organizational, regulatory, and medico-economic barriers remain, and the level of evidence supporting the benefits of telemonitoring is still largely based on observational studies.
Thus, telemedicine applied to home dialysis could emerge in the near future as a major lever for transforming practices, enhancing patient safety and autonomy, improving care efficiency, and paving the way for predictive monitoring strategies incorporating artificial intelligence.