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

BackgroundAssisted 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.MethodsIncident 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).ResultsA 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.ConclusionsThe 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.