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Related Experiment Videos

Ten years' experience with CAPD in a nursing home setting

J E Anderson1

  • 1Division of Renal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.

Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis
|May 1, 1997
PubMed
Summary

Continuous ambulatory peritoneal dialysis (CAPD) in nursing homes offers a viable treatment for end-stage renal disease (ESRD) patients, though survival remains a significant concern, especially for older, impaired individuals.

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Area of Science:

  • Nephrology
  • Geriatrics
  • Internal Medicine

Background:

  • End-stage renal disease (ESRD) management in nursing home settings presents unique challenges.
  • Continuous ambulatory peritoneal dialysis (CAPD) is an option for ESRD patients requiring long-term care.
  • Evaluating CAPD's efficacy and patient outcomes in this population is crucial.

Purpose of the Study:

  • To describe demographic and clinical characteristics of ESRD patients on CAPD in a nursing home.
  • To assess CAPD technique success and patient outcomes.
  • To identify factors influencing survival and discharge in this patient group.

Main Methods:

  • Retrospective review of 109 ESRD patients treated with CAPD in a university-based teaching nursing home from 1986 to 1996.

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  • Analysis included demographic data, clinical characteristics, peritonitis rates, hospitalization rates, and survival analysis (Cox-adjusted).
  • Logistic regression was used to identify predictors of discharge home.

    • Main Results:

    • Six- and 12-month survival rates were 51.7% and 37.2%, respectively.
    • Mortality risks included age >75, poor functional status, coronary artery disease (CAD), and decubitus ulcers. Vascular disease was the leading cause of death.
    • Peritonitis rate was 1.19 episodes/patient/year; hospitalization rate was 22.4 days/patient/year. Discharge was more likely for patients admitted for rehabilitation or with higher ADL scores.

    Conclusions:

    • CAPD is a feasible treatment option for ESRD patients in nursing homes.
    • Technical issues are not limiting, but poor patient outcomes, particularly limited survival for the elderly and functionally impaired, are a significant concern.
    • Informed consent regarding survival expectations is vital. Patients with anticipated discharge are most likely to benefit and return to the community.