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End-stage renal disease in nursing homes: a systematic review.
J Am Med Dir Assoc 2013; 14(4):242-7JA

Abstract

OBJECTIVES/INTRODUCTION

Demand for nursing home (NH) care by patients with end-stage 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) 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. Most articles were multicenter studies that were conducted in the 1990 s. One study focused on patients with stage 5 chronic kidney disease, and the remaining 13 studies focused on patients receiving chronic dialysis, of which eight studies included only those receiving peritoneal dialysis, four studies included patients receiving both peritoneal dialysis and hemodialysis, and one study included only patients receiving hemodialysis. 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.

Authors+Show Affiliations

Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. rasheeda.stephens@duke.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Review
Systematic Review

Language

eng

PubMed ID

23375523

Citation

Hall, Rasheeda K., et al. "End-stage Renal Disease in Nursing Homes: a Systematic Review." Journal of the American Medical Directors Association, vol. 14, no. 4, 2013, pp. 242-7.
Hall RK, O'Hare AM, Anderson RA, et al. End-stage renal disease in nursing homes: a systematic review. J Am Med Dir Assoc. 2013;14(4):242-7.
Hall, R. K., O'Hare, A. M., Anderson, R. A., & Colón-Emeric, C. S. (2013). End-stage renal disease in nursing homes: a systematic review. Journal of the American Medical Directors Association, 14(4), pp. 242-7. doi:10.1016/j.jamda.2013.01.004.
Hall RK, et al. End-stage Renal Disease in Nursing Homes: a Systematic Review. J Am Med Dir Assoc. 2013;14(4):242-7. PubMed PMID: 23375523.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - End-stage renal disease in nursing homes: a systematic review. AU - Hall,Rasheeda K, AU - O'Hare,Ann M, AU - Anderson,Ruth A, AU - Colón-Emeric,Cathleen S, Y1 - 2013/02/01/ PY - 2012/12/23/received PY - 2013/01/03/accepted PY - 2013/2/5/entrez PY - 2013/2/5/pubmed PY - 2013/11/13/medline SP - 242 EP - 7 JF - Journal of the American Medical Directors Association JO - J Am Med Dir Assoc VL - 14 IS - 4 N2 - OBJECTIVES/INTRODUCTION: Demand for nursing home (NH) care by patients with end-stage 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) 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. Most articles were multicenter studies that were conducted in the 1990 s. One study focused on patients with stage 5 chronic kidney disease, and the remaining 13 studies focused on patients receiving chronic dialysis, of which eight studies included only those receiving peritoneal dialysis, four studies included patients receiving both peritoneal dialysis and hemodialysis, and one study included only patients receiving hemodialysis. 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. SN - 1538-9375 UR - https://www.unboundmedicine.com/medline/citation/23375523/End_stage_renal_disease_in_nursing_homes:_a_systematic_review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1525-8610(13)00005-4 DB - PRIME DP - Unbound Medicine ER -