Effects of nursing facility residency on mortality in patients initiating hemodialysis: a retrospective cohort study

As the population of older adults grows and nuclear families become increasingly prevalent, the number of older adults cared for in nursing facilities is rising. We investigated whether undergoing dialysis while residing in a nursing facility impacts mortality rates among dialysis patients. We enrolled 2,597 patients who visited hemodialysis clinics at 17 teaching hospitals and collected data on underlying diseases, laboratory findings, and medications, comparing patients who initiated dialysis during residency in a nursing facility with those who did not. Multivariate survival analysis was then performed to determine whether initiating dialysis while in a nursing facility increased mortality. Of the 2,597 patients, 9.1% (n = 237) initiated dialysis while residing in a nursing facility. Compared with community-dwelling patients, facility residents were older, more often female, and had a higher burden of comorbidities including diabetes, dementia, and cardiovascular disease, along with lower markers of nutritional status. In multivariable Cox regression analysis adjusting for demographic factors, comorbidities, laboratory parameters, and medication use, nursing facility residency at dialysis initiation was independently associated with higher mortality (adjusted HR 1.66, 95% CI 1.30–2.22), corresponding to an approximately 66% increased risk of death. In summary, the current study suggests a correlation between starting dialysis in a nursing facility and a higher mortality rate among dialysis patients.