Older adults on frequent dialysis in skilled nursing facilities report rapid recovery
Older adults with end-stage kidney disease receiving dialysis five times a week in skilled nursing facilities report a rapid recovery time of 2 or less hours, according to data published in Hemodialysis International.
“Cardiovascular and quality of life benefits of more frequent hemodialysis therapy (five or more treatments per week) have been demonstrated for more than 10 years. Improved post-dialysis recovery time (DRT) with more frequent hemodialysis is one of the many quality of life benefits of this form of therapy. Heretofore, these benefits have been demonstrated in a relatively young and robust patient population living at home. Older patients residing in a skilled nursing facility (SNF) have not been studied,” Allen M. Kaufman, MD, chief medical officer and senior vice president of clinical and scientific affairs at Dialyze Direct, told Healio. “Despite 15% of the general dialysis population passing through a SNF at some point each year, little has been published about the natural history of end-stage-renal disease patients residing in a SNF, and virtually nothing about the effect of more frequent dialysis therapy on post-DRT in this group.”
Researchers evaluated 2,309 older adults with ESKD (mean age was 68 years; 53% were men) receiving dialysis from 154 SNFs between Nov. 4, 2019, and June 11, 2021, to determine recovery time after dialysis.
Patients received more frequent dialysis modeled to provide at least 14 treatment hours per week. Researchers asked patients to describe their recovery time after each treatment using the following options: 0 to 0.5 hour, 0.5 to 1 hour, 1 to 2 hours, 2 to 4 hours, 4 to 8 hours, 8 to 12 hours, by the next morning or not even by the next morning. Researchers included patients who reported at least 1 week of DRT in a mixed model logistic regression of rapid recovery.
Overall, patients received a mean of 4.3 weekly dialysis treatments throughout the study period. Analyses revealed 92% of patients receiving at least five treatments a week reported a DRT of less than or equal to 2 hours, despite advanced age, “frailty” and comorbidities.
“Compared to the benchmark post DRT of 8 to 21 hours for conventional dialysis, 92% of patients with more frequent dialysis recovered within 2 hours and 80% recovered within 1 hour. Thus, even the elderly, frail SNF residents with multiple complex medical conditions benefit from more frequent dialysis,” Kaufman told Healio. “The results are highly promising in potentially enhancing the ability of these patients to participate in rehabilitation and restorative services while living in the SNF. This will be the subject of our next set of studies.”