Scarborough General Hospital, Toronto, ON, Canada.
Int Urol Nephrol. 2010 Jun;42(2):545-51. doi: 10.1007/s11255-010-9714-y. Epub 2010 Feb 23.
The mean age of patients with end-stage renal disease increases steadily. The elderly on dialysis have significant comorbidity and require extra attention to meet their dialysis, dietary, and social needs, and some may need to be treated at a long-term care facility such as a nursing home (NH). Providing dialysis and caring for elderly patients in a nursing home (NH) presents a number of challenges. Few data are available in the literature about elderly patients on peritoneal dialysis (PD) in an NH. This paper describes our experience of starting and maintaining a peritoneal dialysis program in three community-based nursing homes.
During the period 2004-2008, after the nursing home personnel had received appropriate training, we established a PD program in three community-based nursing homes and admitted 38 patients on peritoneal dialysis. We educated 112 NH staff over the three-year period. Mean age of the patients at entry was 77.3 + or - 8.5(18.4%) were male. The main causes of end-stage renal disease were diabetes mellitus (DM) 21 (55.8%) and hypertension 13 (34.2%). Comorbid conditions included DM (27, 71.1%), hypertension (26, 68.4%), coronary artery disease (18.5%), chronic heart failure (11, 28.9%), cerebrovascular event (12, 31.6%), and cancer(3, 7.9%). The average total time on chronic peritoneal dialysis was 36.5 + or - 29.8 months, (median 31, range: 1-110 months) of which the average time in the NH program, as of the time of this report, was 18.4 + or - 13.1 months (median 15.5, range: 1-45 months). During the study period, 16 (42.1%) of the patients died, 2 (5.3%) transferred to HD, 2 (5.3%) stopped treatment, and 18 (47.4%) are still in the program. Actuarial patient survival from entry into the NH program was 89.5% at six months, 60.5% at 12 months, 39.5% at 24 months and 13.2% at 36 months. Patient survival from initiation of chronic dialysis was 89.5% at six months, 76.3% at 12 months, 63.1% at 24 months, and 39.5% at 36 months. We observed 28 episodes of peritonitis with a rate of one episode every 40.3 treatment-months. Two PD catheters had to be replaced, giving a rate of one in every 362.5 patient months.
Our results with elderly patients in a nursing home show an excellent patient and technique survival and a low peritonitis rate. With appropriate training of the NH nursing staff, peritoneal dialysis could be performed successfully in these nursing homes. Successful peritoneal dialysis in a nursing home requires a close collaboration between the nursing home staff and PD dialysis unit.
终末期肾病患者的平均年龄稳步上升。接受透析治疗的老年人合并症显著，需要额外关注以满足他们的透析、饮食和社会需求，其中一些人可能需要在疗养院（NH）等长期护理机构接受治疗。在疗养院（NH）为老年人提供透析和护理带来了诸多挑战。关于 NH 中接受腹膜透析（PD）的老年患者，文献中数据很少。本文介绍了我们在 3 家社区疗养院启动和维持 PD 项目的经验。
2004 年至 2008 年期间，在疗养院工作人员接受适当培训后，我们在 3 家社区疗养院建立了 PD 项目，并收治了 38 名腹膜透析患者。在 3 年期间，我们培训了 112 名 NH 工作人员。入组患者的平均年龄为 77.3 ± 8.5（18.4%），其中男性 112 人（55.8%）。终末期肾病的主要病因包括糖尿病（DM）21 例（55.8%）和高血压 13 例（34.2%）。合并症包括 DM（27 例，71.1%）、高血压（26 例，68.4%）、冠状动脉疾病（18.5%）、慢性心力衰竭（11 例，28.9%）、脑血管意外（12 例，31.6%）和癌症（3 例，7.9%）。慢性腹膜透析的总时间平均为 36.5 ± 29.8 个月（中位数为 31，范围：1-110 个月），截至本报告时，NH 项目的平均时间为 18.4 ± 13.1 个月（中位数为 15.5，范围：1-45 个月）。在研究期间，16 名（42.1%）患者死亡，2 名（5.3%）转为血液透析，2 名（5.3%）停止治疗，18 名（47.4%）仍在该项目中。从进入 NH 项目开始，患者的存活率为 6 个月时为 89.5%，12 个月时为 60.5%，24 个月时为 39.5%，36 个月时为 13.2%。从开始慢性透析开始，患者的存活率为 6 个月时为 89.5%，12 个月时为 76.3%，24 个月时为 63.1%，36 个月时为 39.5%。我们观察到 28 例腹膜炎发作，每 40.3 次治疗月发生 1 次。2 根 PD 导管需要更换，每 362.5 例患者月发生 1 次。
我们在疗养院中对老年患者的结果显示出良好的患者和技术生存率以及较低的腹膜炎发生率。通过对 NH 护理人员进行适当培训，可以在这些疗养院中成功进行腹膜透析。疗养院中腹膜透析的成功需要疗养院工作人员和 PD 透析单位之间的密切合作。
