End-Stage Renal Disease in Nursing Homes: A Systematic Review

Abstract

Objectives/Introduction Demand for nursing home (NH) care by patients with endstage renal disease (ESRD) is likely to increase with growing numbers of older adults initiating chronic dialysis. We completed a systematic review to summarize the literature on NH residents with ESRD. Methods MEDLINE, CINAHL, EMBASE, and relevant conference proceedings were searched to identify articles using the following MESH terms or related key words in the title or abstract: “residential facilities”, “renal dialysis”, “renal replacement therapy”, and “chronic kidney failure”. We selected case control, cohort studies, and clinical trials that included older adults with ESRD (defined as those receiving chronic dialysis or those with Stage 5 chronic kidney disease (CKD)) living in residential care facilities. We abstracted information on study design, quality, and results. Results Of 198 unique citations identified by the search strategy, 14 articles met eligibility criteria. The majority of articles were multicenter studies that were conducted in the 1990s. One study focused on patients with Stage 5 CKD, and the remaining thirteen studies focused on chronic dialysis patients of which eight studies included only peritoneal dialysis (PD) patients, four studies included both PD and hemodialysis (HD) patients, and one study included only HD patients. All studies were observational, no clinical trials were identified, and study design limitations and heterogeneity within study populations were common. Summarizing results across these studies suggests that NH residents with ESRD have limited survival, particularly early after dialysis initiation. Functional impairment is highly prevalent in this population and independently associated with poor outcomes. Conclusions NH residents with ESRD appear to be a particularly vulnerable population, but current information on their prevalence, characteristics, and outcomes is limited. Further research is needed to provide a better understanding of modifiable predictors of survival and functional decline in this population.

Association of Nondisease-Specific Problems with Mortality, Long-Term Care, and Functional Impairment among Older Adults Who Require Skilled Nursing Care after Dialysis Initiation

“…Importantly, we found that a higher number of nondiseasespecific problems was associated with higher risk for death, transition to LTC, and functional impairment. Additionally, previous studies have described the lack of data available on patients with ESRD in nursing homes, and studies that have been conducted have focused on those receiving LTC or among those discharged from SNF care (5,23). We studied the effect of nondisease-specific problems among older adults who were not institutionalized before dialysis initiation, of whom nearly one third were living alone before developing ESRD.…”

“…The majority of older adults initiating dialysis do so during a hospitalization, and these patients may require post-acute care services in a skilled nursing facility (SNF) (1,2). Although previous studies of older patients receiving dialysis have reported highintensity hospital care at the time of dialysis initiation and poor health outcomes after dialysis initiation among nursing home residents (2)(3)(4), descriptions of community-dwelling older adults who begin dialysis during a hospitalization and receive subsequent SNF care are limited (5). Because older patients initiating dialysis are medically complex and dialysis can interfere with rehabilitation, they may experience worsening health and may not return home or achieve functional independence (6,7).…”

Breaking the cycle of functional decline in older dialysis patients

“…Currently, older adults comprise nearly one‐third of prevalent US dialysis patients, and this proportion will increase as the population ages. Although a small proportion of older dialysis patients reside in nursing homes, those who live independently in the community have a greater risk of nursing home placement compared to older adults without kidney failure because of a substantially faster rate of functional decline over time . Functional decline is a geriatric syndrome that is characterized as the process of loss of physical and/or cognitive function and manifest as needing assistance with basic activities (eg, walking, dressing, or remembering to take medication) .…”

Transplant Professionals’ Perceptions of Long-Term Care Residents’ Candidacy for Kidney Transplantation

“…The relevant literature suggests that patients with ESRD living in nursing homes have increased morbidity and mortality compared with patients with ESRD who do not. 17 The US Renal Data System reported that the unadjusted overall survival is 26.0% among nursing home residents with ESRD, 41.0% for those with chronic kidney disease (CKD), and 58.0% for non-CKD residents in nursing homes. 8 In our survey, a large percentage of participants considered the LTC setting itself a contraindication to transplantation.…”