. Author manuscript; available in PMC: 2014 Apr 1.

Published in final edited form as: J Am Med Dir Assoc. 2013 Feb 1;14(4):242–247. doi: 10.1016/j.jamda.2013.01.004

Table 1. Characteristics of Studies.

Reference	Study Design	Cohort and Facility Characteristics	Outcome Measures	Main Findings
Anderson et al.¹¹	Prospective	228 PD and HD	Prevalence;	Point – prevalence: 0.4–0.6% of ESRD network population lived in NH
(1993)	cohort	patients	Survival rate;
		Mean age= 65.5	Discharge Disposition)	Survival rates from Date of NH admission:
				6 months- 56%
		Multiple NHs in 4		12 months- 42%
		states: VA, WV, MD,
		DC		12 month survival (Discharged vs. not discharged): 66% vs. 36%, p<0.05
				Predictors of poor survival:
				age>75 (reference (ref): age< 75): HR 1.7 (1.4–2.1)
				PD (ref: HD): HR 2.0 (1.6–2.6)
				ADL <8 (ref: ADL>8) HR 1.7 (1.5–2.5)
				Discharge home:17%

Anderson et al.⁶ (1997)	Prospective	109 PD patients	Survival rate;	Survival rates from Date of NH admission:
	cohort	Mean age = 62.7	Discharge Disposition;	6 months - 52%
			Dialysis-Related Outcomes	12 months -37%
		A 233-bed academic
		nursing home in		Predictors of poor survival:
		Baltimore, MD		Age >75 (ref: age<75): HR 4.75 ( 2.56–8.86);
				ADL (ref: 1 ADL point lower): HR 0.91 (0.87–0.96)
				CAD: HR 1.65 (1.09–2.5)
				Decubitus Ulcer: HR 1.84 (1.15–2.92)
				Discharge home: 37%;
				Hospitalization rate: 22.4 days per patient-year
				Predictors of discharge home:
				Rehab admission: OR 19.14 (5.16, 71)
				ADL score >8 (ref: ADL score <8): OR 4.16 (1.37–12.66)
				Peritonitis rate:1 episodes per 10 patient-months
				Exit-site infection rate: 1 episode per 60 patient-months

Anderson et al.¹⁴	Prospective	109 PD patients	Survival rate;	Survival rates from Date of NH admission:
(2006)	cohort	Mean age = 62.7	Advance Care Planning	6 months: 51%
				12 months: 37%
		A 233-bed academic
		nursing home in		12 month survival (DNAR vs. no DNAR): 21% vs. 44%, p<0.02
		Baltimore, MD
				Proportion with advance directives: 99%
				DNAR: 36%; DNH: 13%
				Predictors of DNAR status:
				Older age: OR 1.04 (1.0007, 1.09)
				CAD: OR 4.24 (1.49, 12.02)
				Lower ADL score: OR 1.22 (1.08, 1.38)

Carey et al.¹²	Prospective	84 PD patients	Survival rate;	Cumulative Survival Rates from Date of NH admission:
(2001)	cohort	Mean age = 65.3	Discharge Disposition;	6 months – 50%
			Dialysis-Related Outcomes	12 months – 40%
		10 community based
		facilities in		Discharge home:37%;
		New Haven, CT		Hospitalization rate: 44.6 days per patient-year
				Peritonitis Rate: 1 episode per 9.6 patient-months

Dharmarajan et al.¹⁰	Cross-	323 NH residents	Prevalence	Prevalence of Stage 5 CKD: 0.9%
(2010)	sectional	Mean age = 83.4
	study
		A 350 bed urban
		long-term care facility
		in
		Bronx, NY

Hariprasad et al.¹⁹	Retrospective	9 PD patients	Dialysis-Related Outcomes	Peritonitis Rate: 1 episode in 131 patient-months
(1995)	chart review	Mean age = NR
		A community based
		facility in Hornell, NY

Kurella Tamura et al.¹⁶	Prospective	3702 incident dialysis	Survival rate;	Survival Rates from Date of HD initiation:
(2009)	cohort	patients (PD and HD)	Functional Impairment	6 months - 50%
		Mean age = 73.4		12 months - 25%
		National sample of		Maintenance of baseline functional status:
		NHs identified by		6 months - 27%
		linkage of MDS and		12 months -13%
		USRDS datasets
				Predictors of maintenance of functional status:
				Older age (per 10yr): OR 0.6 (0.5–0.7)
				White race: OR 0.7 (0.5–0.9)
				Cerebrovascular disease: OR 0.7 (0.5–0.9)
				Dementia: OR 0.6 (0.4–0.9)
				Hospitalization at start: OR 0.6(0.5–0.8)
				Albumin <3.5g/dL: OR 0.6(0.4–0.8)

Kurella Tamura et al. ¹⁸	Prospective	2402 incident dialysis	Cognitive Impairment	Proportion of patients with early dialysis initiation = 18%
(2010)	cohort	patients (PD and HD)	Dialysis-Related Outcomes
		Mean age = 73		Predictors of early dialysis initiation:
				Edema: OR 1.54 (1.24–1.92)
		National sample of		Dyspnea: OR 1.95 (1.40–2.73)
		NHs identified by		Moderate to severe cognitive impairment: OR 0.84 (0.67, 1.04)
		linkage of MDS and		Decline in cognitive function: OR 1.48 ( 1.17–1.88)
		USRDS datasets

Meddy ¹⁷	Prospective	32 PD patients	Discharge Disposition;	Discharge from NH: 6%
(1995)	cohort	Median age = 71	Dialysis-Related Outcomes	Peritonitis rate: 1 episode per 15 patient-months
		A 220 bed for-profit
		nursing home in
		Brooklyn NY

Reddy et al.¹³	Prospective	271 HD patients	Survival rate;	Survival rates from Date of NH admission:
(2007)	cohort	Mean age = 70.5	Discharge Dispositoin	6 months - 38%
				12 months -26%
		5 NHs in Chicago, IL		Median = 4.1 mo
				Survival rates from Date of HD initiation:
				6 months - 75%
				12 months - 66%
				Median = 3.4 mo
				Median Survival by dialysis vintage:
				New (< 3 months of dialysis): 3.4 months
				Intermediate (3–12 months of dialysis): 3.5months
				Established (> 12 months of dialysis): 5.1 months (vs. New, p<0.01; vs.
				Intermediate, p=0.01)
				Discharge from NH: 37%
				New vs. Established: 28% vs. 48%, p=0.01

Taskapan et al. ⁹	Retrospective	38 PD patients	Survival rate;	Survival rates from Date of NH admission:
(2010)	chart review	Mean age = 77.3	Dialysis-Related Outcomes	6 months – 89.5%
				12 months – 60.5%
		3 NHs in
		Scarborough, Toronto		Survival rates from Date of PD initiation:
				6 months –89.5 %
				12 months – 76.3%
				Peritonitis Rate: 1 episode in 40.3 patient-months
				Exit-site infection rate: 1 episode per 42.4 patient-months

Troidle et al.²⁰	Retrospective	77 PD patients	Dialysis-Related Outcomes	Peritonitis rate: 1 episode per 19.8 patient-months
(2008)	chart review	Mean age = 66
				Characteristics of peritonitis population (vs. no peritonitis) :
		Unknown number of		Proportion of African-American race: 41% vs. 23%, p < 0.05
		Nursing homes close		Average length of NH stay: 106 vs. 77 days, p < 0.05
		to a dialysis unit
		located in New
		Haven, CT

USRDS¹⁵	Prospective	3,748 incident dialysis	Survival rate;	Survival rates from Date of HD initiation:
(2011)	cohort	patients (PD and HD)	Functional Impairment	6 months - 26%;
		Mean age = 84.2		12 months – 14%
		National sample of		Predictors of Death at 6 months(among all NH residents):
		NHs identified by		Recent Dialysis Initiation (ref: non-CKD NH residents): HR 2.54 (2.36-
		linkage of MDS and		2.73)
		USRDS datasets
				Maintenance of baseline functional status:
				6 months - 10%
				12 months - 6%
				Maintenance of baseline cognitive scores:
				6 months – 17%
				12 months – 10%
				Predictor of maintenance of functional status at 6 months:
				Recent Dialysis Initiation (ref: non-CKD NH residents): OR 0.69 (0.69
				0.58–0.82)

Wang et al. ⁸	Retrospective	8 PD patients	Dialysis-Related Outcomes	Peritonitis rate:
(2002)	chart review	Mean age = 77.3		1 episodes per 7.5 patient-months
		A community based
		facility in Toronto

Abbreviations: PD, peritoneal dialysis; HD, hemodialysis; NH, nursing home; ESRD, end-stage renal disease; ADL, activities of daily living; HR, hazard ratio; CAD, coronary artery disease; SD, standard deviation; DNAR, do not attempt resuscitation; DNH, do not hospitalize; OR, odds ratio; CKD, chronic kidney disease; NR, not reported; MDS, Minimum Data Set; USRDS, United States Renal Data System.