Peritoneal dialysis with trained home nurses in elderly and disabled end-stage renal disease patients

This study was designed to investigate trained home nurses in the care of elderly and disabled end-stage renal disease (ESRD) patients receiving peritoneal dialysis (PD) in all the patients who entered our home program between January 1989 and December 1992. We trained nursing staff from nursing agencies to do PD. A weekly nursing summary including daily vitals, PD flow sheet, medications, and progress notes was sent to the home program. The trained nurses were also utilized temporarily during acute deterioration of patients or partners resulting in the inability to do PD. Eleven patients were female, 10 were male, with a mean age of 62 years (range 30-81 years). Ten patients (48%) had diabetes mellitus. Thirteen patients performed continuous ambulatory peritoneal dialysis (CAPD) and 8 patients continuous cycling peritoneal dialysis. Five patients required home nurses temporarily for a period of 1-8 weeks until the patients became independent. Two patients were transferred to incenter hemodialysis, one because of insurance and one because of fungal peritonitis. One patient recovered renal function after 22 months of PD. Thirty-three episodes of peritonitis occurred over 417 patient-months (one episode/13 patient-months). Three patients needed catheter removal secondary to Candida peritonitis. Hospitalization rate and duration of stay were lower (1 admission/6 patient-months) than patient-months without home nurses (1/4 patient-months). The main causes of these admissions were diabetic complications (38%), cardiac disease (20%), and peritonitis (14%). In conclusion, our experience suggests that elderly and disabled patients on PD with home nurses have a favorable outcome even with multiple, comorbid conditions.