An updated review: Health outcomes in nursing home patients on dialysis.

Abstract

Nursing home patients receiving dialysis are known to be an especially high-risk population due to advanced age and various co-morbidities. Previously, we reported the results of a large epidemiological study (n=3,943) using longitudinal data from an independent nursing home dialysis provider. The objective of the current study was to update the analyses of outcomes in dialysis patients in the nursing home setting using an observational epidemiological database with a larger population and more recent data. Health status and outcomes were evaluated for 6,314 patients who received hemodialysis treatinent in the nursing home setting between 2006 and. 2015. Analyses included monthly mortality rates, Kaplan-Meier survival analysis, and laboratory values. Patients had poor initial health status, with an incident first month annualized monthly mortality rate of 58%, mean hemoglobin of 10.0 g/dL, and mean serum albumin of 3.2 g/dL. Health status improved over time, with annual mortality rates in the range of 30% during months 4-12, and 21% during months 13-24. Mean serum albumin rose to approximately 3.5 g/dL and hemoglobin was stable at approximately 10.8 g/dl. Overall survival was 93%, 82%, 74%, and 63% at 1, 3, 6, and 12 months, respectively. These study results confirm our previous find- ings that nursing home patients on dialysis have poor initial health status. However, outcomes improved over time, and survival analyses indicate that long-term outcomes compare favorably to previously published studies of nursing home patients on dialysis.