Ten years' experience with CAPD in a nursing home setting.

OBJECTIVE

We reviewed our experience with end-stage renal disease (ESRD) patients treated with continuous ambulatory peritoneal dialysis (CAPD) in a nursing home with the aims of describing their demographic and clinical characteristics, evaluating CAPD technique success and patients outcomes.

SETTING

University-based, teaching nursing home.

DESIGN

Retrospective review of patients in our nursing home treated with CAPD between 1 June 1986 and 1 June 1996.

PATIENTS

One hundred and nine patients: 66 (60.5%) were female and 59 (54%) were white. Their mean age was 62.7 years +/- 12.8 SD (range 31-88). Females were significantly older than males (64.9 years +/- 10.7 SD vs 59.1 years +/- 14.6 SD, p < 0.05). Sixty-eight (62.4%) were diabetics. MAIN OUTCOMES STUDIED: Cox-adjusted patient survival. Cause of death. Peritonitis and hospitalization rates. Logistic analysis of predictors of discharge home.

RESULTS

Six- and 12-month survival rates were 51.7% and 37.2%, respectively. Age greater than 75, poor functional status, coronary artery disease (CAD), and decubitus ulcers were significant mortality risks. Vascular disease was the leading cause (41.7%) of death. The peritonitis rate in the nursing home was 1.19 episodes per patient year. Gram-positive organisms predominated. The hospitalization rate was 22.4 days per patient year. Gangrene/ stump infections and peritonitis accounted for 14% and 10% of admissions. Those patients admitted for rehabilitation and with higher activity of daily living (ADL) scores were more likely, and those with diabetes, age > or = 75, and CAD less likely to be discharged.

CONCLUSIONS

We continue to believe that peritoneal dialysis is a reasonable option for ESRD patients placed in nursing homes. Technical problems do not limit its use, but overall poor patient outcomes are an important issue. Patients, their families and referring physicians should be informed of the limited survival expectations particularly for the very old and/or severely functionally impaired patient. Patients whose discharge is anticipated on admission are those most likely to return to the community and are the most likely to truly benefit from nursing home placement.