title: End-stage renal disease in nursing homes: a systematic review.
abstract: OBJECTIVE
  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: Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. rasheeda.stephens@duke.edu
authors: Rasheeda K
authors: RK
authors: Hall
authors: Ann M
authors: AM
authors: O'Hare
authors: Ruth A
authors: RA
authors: Anderson
authors: Cathleen S
authors: CS
authors: Colón-Emeric
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D055317:Evidence-Based Practice; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006304:Health Status; D006707:Homes for the Aged / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000458:organization & administration / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012307:Risk Factors; D012720:Severity of Illness Index; D012866:Skilled Nursing Facilities / Q000458:organization & administration / Q000706:statistics & numerical data*; D016019:Survival Analysis
references: Nephrol Dial Transplant. 2007 May;22(5):1399-406
references: 17259652
references: Ann Intern Med. 2007 Feb 6;146(3):177-83
references: 17283348
references: J Am Geriatr Soc. 2003 Feb;51(2):213-21
references: 12558718
references: Kidney Int. 2008 Jun;73(11):1289-95
references: 18354381
references: BMC Health Serv Res. 2011 Apr 20;11:86
references: 21507213
references: Adv Perit Dial. 1998;14:127-30
references: 10649709
references: N Engl J Med. 2009 Oct 15;361(16):1539-47
references: 19828531
references: N Engl J Med. 2009 Oct 15;361(16):1612-3
references: 19828543
references: Arch Phys Med Rehabil. 2004 Jan;85(1):51-3
references: 14970967
references: J Am Med Dir Assoc. 2009 Feb;10(2):120-6
references: 19187880
references: Adv Chronic Kidney Dis. 2008 Apr;15(2):115-22
references: 18334235
references: Am J Kidney Dis. 2001 Mar;37(3):580-7
references: 11228183
references: Int Urol Nephrol. 2010 Jun;42(2):545-51
references: 20174996
references: J Am Med Dir Assoc. 2010 May;11(4):297-9
references: 20439053
references: Nephrol Dial Transplant. 2008 Apr;23(4):1396-400
references: 18057068
references: Am J Kidney Dis. 1993 Jun;21(6):619-27
references: 8503415
references: Am J Kidney Dis. 2006 Jul;48(1):122-7
references: 16797394
references: Am J Kidney Dis. 2008 Jan;51(1 Suppl 1):S1-320
references: 18086389
references: Am J Kidney Dis. 2010 Dec;56(6):1117-26
references: 20974509
references: Adv Chronic Kidney Dis. 2007 Oct;14(4):402-8
references: 17904507
references: Int Urol Nephrol. 2002;34(3):405-8
references: 12899237
references: Perit Dial Int. 1997 May-Jun;17(3):255-61
references: 9237286
references: Am J Kidney Dis. 1990 Aug;16(2):137-41
references: 2382650
references: Semin Dial. 2012 Nov-Dec;25(6):649-56
references: 23095079
references: Adv Ren Replace Ther. 2000 Jan;7(1):78-84
references: 10672920
references: Am J Kidney Dis. 2000 Jun;35(6):1061-7
references: 10845817