Hospitalizations in Dialysis Patients in Canada: A National Cohort Study

Abstract

Background:Hospitalizations of chronic dialysis patients have not been previously studied at a national level in Canada. Understanding the scope and variables associated with hospitalizations will inform measures for improvement.Objective:To describe the risk of all-cause and infection-related hospitalizations in patients on dialysis.Design:Retrospective cohort study using health care administrative databases.Setting:Provinces and territories across Canada (excluding Manitoba and Quebec).Patients:Incident chronic dialysis patients with a dialysis start date between January 1, 2005, and March 31, 2014. Patients with a prior history of kidney transplantation were excluded.Measurements:Patient characteristics were recorded at baseline. Dialysis modality was treated as a time-varying covariate. The primary outcomes of interest were all-cause and dialysis-specific infection-related hospitalizations.Methods:Crude rates for all-cause hospitalization and infection-related hospitalization were determined per patient year (PPY) at 7 and 30 days, and at 3, 6, and 12 months postdialysis initiation. A stratified, gamma-distributed frailty model was used to assess repeat hospital admissions and to determine the inter-recurrence dependence of hospitalizations within individuals, as well as the hazard ratio (HR) attributed to each covariate of interest.Results:A total of 38 369 incident chronic dialysis patients were included: 38 088 adults and 281 pediatric patients (age less than 18 years). There were 112 374 hospitalizations, of which 11.5% were infection-related hospitalizations. The all-cause hospitalization rate was similar for all adult age groups (age 65 years and older: 1.40, 1.35, and 1.18 admissions PPY at 7 days, 30 days, and 6 months, respectively). The all-cause hospitalization rate was higher for pediatric patients (1.67, 2.48, and 2.47 admissions PPY at 7 days, 30 days, and 6 months, respectively; adjusted HR: 2.73, 95% confidence interval [CI]: 2.37-3.15, referent age group: 45-64 years). Within the first 7 days after dialysis initiation, patients on peritoneal dialysis had a higher risk of all-cause hospitalization (HR: 1.27, 95% CI: 1.07-1.50) and infection-related hospitalization (HR: 2.05, 95% CI: 1.19-3.55) compared with patients on hemodialysis. Beyond 7 days, the risk did not differ significantly by dialysis modality. Female sex and Indigenous race were significant risk factors for all-cause hospitalization.Limitations:The cohort had too few home hemodialysis patients to examine this subgroup. The outcome of infection-related hospitalization was determined using diagnostic codes. Dialysis patients from Manitoba and Quebec were not included.Conclusions:In Canada, the rates of hospitalization were not influenced by dialysis modality beyond the initial 7-day period following dialysis initiation; however, the rate of hospitalization in pediatric patients was higher than in adults at every time frame examined.

Risk factors and outcomes of cardiovascular disease readmission within the first year after dialysis in peritoneal dialysis patients

“…Although several studies focused on the burden, correlates and outcomes of readmission in PD patients [ 6–9 , 13 , 14 ], these studies mainly considered short-term readmission with durations ranging from 7 to 120 days. Knowledge regarding the incidence, risk factors and long-term outcome within the first year after dialysis in PD patients, especially CVD readmission, is limited.…”

Characteristics and Effectiveness of Dedicated Care Programs for Patients Starting Dialysis: A Systematic Review

“…During this time, the hospitalization rate at 90-days approaches 1.4 admissions per patient year and the mortality rate at 180-days for patients >65 years is 44% (1,2). These poor outcomes after starting dialysis are multifactorial, related not only to dialysis complications but also pre-existing comorbidities, cardiovascular disease, and infection (2,3). Functional status and mental health are also negatively affected (4,5), further compounding the healthcare needs for an increasingly elderly incident dialysis population (6).…”

“…The transition period during dialysis initiation, particularly the first few months, is associated with increased morbidity and mortality. During this time, the hospitalization rate at 90-days approaches 1.4 admissions per patient year and the mortality rate at 180-days for patients >65 years is 44% (1,2). These poor outcomes after starting dialysis are multifactorial, related not only to dialysis complications but also pre-existing comorbidities, cardiovascular disease, and infection (2,3).…”

Could symptom burden predict subsequent healthcare use in patients with end stage kidney disease on hemodialysis care? A prospective, preliminary study

“…Patients on HD have a high rate healthcare use [hospitalization and emergency department (ED) visits] [6,7], that further increases the total healthcare cost associated with HD. Predictors of higher healthcare use in this patient population include age, socioeconomic status, marital status, and medical comorbidity [6,[8][9][10][11]. Furthermore, depressive symptoms [12] and psychosocial distress [9,13] has also been associated with poorer survival and higher healthcare use.…”