Untitled

Abstract

Our experience suggests that peritoneal dialysis can be achieved in a community-based nursing home. This requires a systematic training program for the LTCF personnel and the availability of a "dedicated" nephrology dialysis staff. This is crucial to the success of the program. It is important that patients, their families and ESRD care professionals are informed of the limited survival expectation particularly for very old and severely impaired patients.

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

“…Among the three other prospective studies, peritonitis rates were 1 episode per 10–15 patient-months, and these rates were reported to be higher than in the community 6,12 . In contrast, peritonitis rates from retrospective chart reviews ranged from 1 episode per 7 patient-months to 1 episode per 40 patient-months 8,9,20 . Direct comparisons of these rates are limited by variation in assessment of peritonitis and study design (prospective vs. retrospective), as well as differences in patient populations (Canadian vs. United States; NH characteristics; average length of stay).…”

“…The prospective studies included in this review suggest that that it is feasible to conduct PD in NHs with appropriate staff training and support 6,12,17,19 . While three studies found higher peritonitis rates in NH residents compared to in the community 6,8,12 , there are likely underlying differences in the health and comorbidities of these patients which explain at least part of the higher infection rate. These limitations also affect generalizability of data on hospitalization rates, exit site infections, and transitions to HD.…”

“…The majority of studies (9 of 14) encompassed study periods between 1985 and 2000. Most studies had multicenter cohorts from various NHs located in the United States, while two studies examined outcomes in NHs located in Toronto, Canada 8,9 . Mean subject age ranged from 63 to 83 years.…”

“…No studies examined clinical outcome measures relevant to ESRD and hemodialysis (i.e., anemia, nutrition, bone disease, dialysis adequacy, or hemodialysis access type), although seven studies reported outcomes related to PD, with some consistent and some conflicting findings 6,8,9,12,17,19,20 . In these studies, NH staff were specifically trained to do PD exchanges, and in several studies, nurses from the dialysis unit were available for regular patient assessments and troubleshooting.…”

“…In these studies, NH staff were specifically trained to do PD exchanges, and in several studies, nurses from the dialysis unit were available for regular patient assessments and troubleshooting. Peritonitis rates (defined as effluent with greater than 100 white blood cells per milliliter in 4 of 7 studies 6,8,12,20 ) varied markedly across studies, ranging from 1 episode per 7 patient-months to 1 episode per 131 patient-months. The lowest peritonitis rate was reported in a prospective study of nine PD patients whose length of stay was not reported 19 .…”