Hospital admissions in elderly patients on chronic hemodialysis

Sun, Yijuan; Kassam, Hussein A.; Adeniyi, Muniru; Martinez, Milagros; Agaba, Emmanuel I; Onime, Aideloje; Servilla, Karen S.; Raj, Dominic S.; Murata, Glen H.; Tzamaloukas, Antonios H.

doi:10.1007/s11255-011-9913-1

Cited by 12 publications

(12 citation statements)

References 41 publications

(32 reference statements)

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“…There are also racial and ethnic differences in the processes of care, including dialysis dose (6,7), anemia treatment (8,9), hemodialysis vascular access (10)(11)(12)(13), and pre-ESRD clinical care (12,14). Prior studies examining hospitalization in dialysis patients usually used race, among others, as an explanatory factor or control variable (15)(16)(17)(18)(19)(20)(21). To our knowledge, no studies have assessed the association of hospitalizations with race/ethnicity and age at a national level.…”

Section: Introductionmentioning

confidence: 99%

Race/Ethnicity, Age, and Risk of Hospital Admission and Length of Stay during the First Year of Maintenance Hemodialysis

Gao

Norris

Greene³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Although patients undergoing maintenance hemodialysis have exceptionally high hospitalization rates, the risk factors for hospitalizations are unclear. This study sought to examine hospitalization rates among hemodialysis patients in the United States according to both race/ethnicity and age.Design, setting, participants, & measurements US Renal Data System data on 563,281 patients beginning maintenance hemodialysis between 1995 and 2009 were analyzed. Rates of hospital admission and number of hospital days for all-cause and cause-specific hospitalizations during the first year of dialysis were compared among blacks, whites, and Hispanics in the entire cohort and subgroups stratified by age.Results After multiple adjustments, compared with whites, Hispanics overall had lower rates of both all-cause hospital days (adjusted rate ratio [aRR], 0.91; 95% confidence interval [95% CI], 0.90 to 0.93; P,0.001) and hospital admissions (aRR, 0.89; 95% CI, 0.88 to 0.90; P,0.001), whereas blacks had a lower rate of all-cause admissions (aRR, 0.95; 95% CI, 0.94 to 0.96; P,0.001). The racial/ethnic differences, however, varied by age. Hispanics exhibited the lowest rates of hospital days and admissions for all age groups#70 years, but those .80 years had higher rates than their white counterparts. The adjusted black-to-white rate ratios exhibited a U-shaped pattern with age, with higher rates for blacks in the younger and older age groups. Hospitalization rates for dialysisrelated infections were markedly higher in blacks and Hispanics than whites, which were consistent in all age groups for blacks (aRRs for hospital days ranged from 1.09 to 1.36) and all ages.60 years for Hispanics (aRRs ranged from 1.20 to 1.38).Conclusions There are significant racial/ethnic differences in hospitalization rates within first year of dialysis, which are not consistent across the age groups and also differ by causes of hospitalization. Overall, blacks and Hispanics had lower rates of all-cause hospital admissions than whites. However, younger and older blacks and older Hispanics were at greatest risk.

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Section: Introductionmentioning

confidence: 99%

Race/Ethnicity, Age, and Risk of Hospital Admission and Length of Stay during the First Year of Maintenance Hemodialysis

Gao

Norris

Greene³

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…Missing dialysis sessions is associated with morbidity 34 and mortality 35 . In the present study, 72 patients (18.9%) were found to have poor adherence using a previously developed compliance index 29 and poor adherence was a predictor of hospitalization 36 …”

Section: Discussionmentioning

confidence: 59%

“…35 In the present study, 72 patients (18.9%) were found to have poor adherence using a previously developed compliance index 29 and poor adherence was a predictor of hospitalization. 36 Finally, depression can affect rates of hospitalization after HD initiation. Depression, developing in large numbers of patients on HD, is underdiagnosed 37 and is associated with cardiovascular events 38 and increased hospitalization rate and length.…”

Section: Discussionmentioning

confidence: 99%

Hospitalizations before and after initiation of chronic hemodialysis

Kassam

Sun

Adeniyi

et al. 2011

Hemodialysis International

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Hospitalization rate is high in patients on chronic hemodialysis (HD). We investigated whether initiation of HD changes the rate and length of hospitalization. We analyzed hospitalizations in HD patients in one hospital over 15 years. We compared annual rate and length of hospitalizations, both presented as mean (95% confidence interval [CI]) between the pre-HD and HD period. Three hundred ninety-two patients, 98% men, 59% diabetic, and 66.3 ± 11.2 years old at the onset of HD, had 1016 hospitalizations in the pre-HD period (60.0 ± 42.9 months) and 1627 hospitalizations in the HD period (32.5 ± 25.9 months). Higher values were found in the HD than the pre-HD period for rate, (pre-HD 0.557 [95% CI 0.473-0.611], HD 2.198 [95% CI 1.997-2.399] admissions/[patient-year], P<0.001) and length (pre-HD 4.63 [95% CI 3.71-5.55], HD 28.07 [95% CI 23.55-32.59] days/patient-year], P<0.001) of hospitalizations for all causes, cardiac disease, infections, vascular access, peripheral vascular disease, metabolic disturbances, gastrointestinal diseases, and miscellaneous conditions, mainly respiratory illness and malignancy. Similar differences were found when we compared the year before and the year after the start of HD. Diabetics had higher all cause rate and length of hospitalizations than non-diabetics in the pre-HD and HD periods. The rate and length of hospitalizations was higher in the HD than the pre-HD period for both HD-specific conditions and conditions encountered in both HD and general populations. Study of factors specific to HD that may affect these conditions should constitute the first step toward improving the morbidity of patients on HD.

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“…Variables selected for inclusion in all multivariable models were based on clinical judgment and known predictors derived from the literature. These variables included age, CCI, gender, previous nephrology follow-up and Caucasian race [12,20,21,22,23,24]. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) were estimated from a multivariable Cox proportional hazards model.…”

Section: Methodsmentioning

confidence: 99%

Suboptimal Initiation of Home Hemodialysis: Determinants and Clinical Outcomes

et al. 2013

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Background/Aims: Suboptimal initiation of conventional hemodialysis is associated with poor clinical outcomes. In this study, we aimed to ascertain the determinants and adverse events associated with suboptimal starts in home hemodialysis (HHD). Methods: We conducted a retrospective cohort study including consecutive incident HHD patients from January 1996 to December 2011. All patients had HHD as their first renal replacement therapy or returned to HHD after kidney transplantation. A suboptimal start was defined by dialysis initiation as an inpatient or with a central venous catheter. The primary outcome was time to first hospitalization, technique failure or death. Secondary outcomes included hospitalization rate, hospital days and determinants of suboptimal starts. Suboptimal starts were further categorized as unavoidable as adjudicated by two independent observers with prespecified criteria. Results: Among 95 incident HHD patients, 44 (46%) and 51 (54%) had optimal and suboptimal starts, respectively. A suboptimal start was associated with a shorter time to the primary outcome (log-rank p < 0.001). In a multivariable Cox proportional hazards model, the hazard ratio for the composite outcome (comparing suboptimal to optimal starts) was 2.94 (95% confidence interval, CI, 1.49-5.78, p = 0.002). Transplantation clinic follow-up (OR 3.18, 95% CI 1.15-8.79) and the Charlson comorbidity index (OR 1.47, 95% CI 1.09-1.97) were associated with higher odds of suboptimal start. Conclusion: Suboptimal initiation of HHD is associated with adverse clinical events including early hospitalization. Given the high proportion of suboptimal starts in patients returning from transplantation, better incorporation of dialysis planning and renal replacement therapy education is warranted.

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Hospital admissions in elderly patients on chronic hemodialysis

Abstract: Hospitalizations, which affect quality of life, differ little between elderly and younger patients on HD. Therefore, hospitalizations do not constitute an argument for restricting access to HD to elderly patients.

Cited by 12 publications

References 41 publications

Race/Ethnicity, Age, and Risk of Hospital Admission and Length of Stay during the First Year of Maintenance Hemodialysis

Race/Ethnicity, Age, and Risk of Hospital Admission and Length of Stay during the First Year of Maintenance Hemodialysis

Hospitalizations before and after initiation of chronic hemodialysis

Suboptimal Initiation of Home Hemodialysis: Determinants and Clinical Outcomes

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