Continuous peritoneal dialysis and the extended care facility

The projected disproportionate increase in the number of elderly patients r eaching end-stage renal disease constitutes a dramatic change in dialysis d emographics. The nursing home or extended care facility (ECF) will become a n increasingly important feature of care for both rehabilitation and long-t erm patient management. For continuous peritoneal dialysis (CPD), the ECF h as been critically evaluated in only a single specialized, university-based , geriatric facility that included trained peritoneal dialysis nurses provi ding care. We have trained multiple ECF personnel in 10 community-based ECF s to provide all CPD-related therapy for 93 patients between November 1993 and December 1998, for a total of 289.3 patient-months. All ECFs have maint ained their CPD program. Outcome measures, Including hospitalization, morta lity, technique failure, and peritonitis rates, show the success and feasib ility of using community-based ECFs for CPD, The use of multiple ECFs for C PD appears to offer distinct advantages over solo structured ECF programs w ithout jeopardizing outcomes. A highly structured CPD education program for ECF personnel by nephrology staff is manageable and appears critical for t he success of maintaining CPD in the ECF. (C) 2001 by the National Kidney F oundation, Inc.