Risk factors for hospitalization among older, incident haemodialysis patients

Schoonover, Kimberly; Hickson, La Tonya J.; Norby, Suzanne M.; Hogan, Marie C.; Chaudhary, Sanjay; Albright, Robert C.; Dillon, John; McCarthy, James T.; Williams, Amy W.

doi:10.1111/nep.12129

Cited by 26 publications

(28 citation statements)

References 29 publications

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“…Approximately 50%–65% of our incident outpatient hemodialysis patients had first initiated in-hospital RRT 16 . This experience is common across the U.S. and other regions 15,17,27,32 .…”

Section: Discussionmentioning

confidence: 99%

“…An AKI episode occurred during hospitalization in 53% and 64% of the total veteran cohort initiated in-hospital RRT. At the time of hospital discharge, patients carry additional burdens of physical debility, infection or wound management, re-hospitalization risk, and/or loss of independence, especially among elderly patients 16,34,35 . As such, the complexity of new outpatient hemodialysis patients who started RRT in the hospital is often overwhelming for both patients and the providers who manage them…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Outpatient Kidney Function Recovery Among Patients Who Initiate Hemodialysis in the Hospital

Hickson

Chaudhary

Williams

et al. 2015

American Journal of Kidney Diseases

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Background Recent policy clarifications by the Centers for Medicare and Medicaid Services have changed access to outpatient dialysis care at end stage renal disease (ESRD) facilities for individuals with acute kidney injury in the United States. Tools to predict “ESRD” and “acute” status in terms of kidney function recovery among patients who previously initiated dialysis in the hospital could help inform patient management decisions. Study Design Historical cohort study Setting & Participants Incident hemodialysis patients in the Mayo Clinic Health System who initiated in-hospital RRT and continued outpatient dialysis following hospital dismissal (2006 to 2009) Predictor Baseline estimated glomerular filtration rate (eGFR), sepsis/surgery acute tubular necrosis (ATN), heart failure, intensive care unit, and dialysis access. Outcomes Kidney function recovery defined as sufficient kidney function for outpatient hemodialysis discontinuation. Results Cohort consisted of 281 patients with mean age 64 years, 63% men, 45% heart failure, and baseline eGFR ≥30 mL/min/1.73m2 in 46%. Over a median 8 months, 52 (19%) recovered, most (94%) within 6 months. Higher baseline eGFR (Hazard Ratio 1.27 per 10 ml/min/1.73m2; 95% CI 1.16–1.39; p<0.001), ATN from sepsis or surgery (HR 3.34; CI 1.83- 6.24; p<0.001), and heart failure (HR 0.40; CI 0.19–0.78, p=0.007) were independent predictors of recovery within 6 months while first RRT in the intensive care unit and a catheter dialysis access were not. There was a positive interaction between absence of heart failure and eGFR≥30 ml/min/1.73m2 for predicting kidney function recovery (p<0.001). Limitations Sample size. Conclusions Kidney function recovery in the outpatient hemodialysis unit following in-hospital RRT initiation is not rare. As expected, higher baseline eGFR is an important determinant of recovery. However, patients with heart failure are less likely to recover even with higher baseline eGFR. Consideration of these factors at hospital discharge informs decisions on “ESRD” status designation and long-term hemodialysis care.

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“…Approximately 50%–65% of our incident outpatient hemodialysis patients had first initiated in-hospital RRT 16 . This experience is common across the U.S. and other regions 15,17,27,32 .…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictors of Outpatient Kidney Function Recovery Among Patients Who Initiate Hemodialysis in the Hospital

Hickson

Chaudhary

Williams

et al. 2015

American Journal of Kidney Diseases

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“…Mayo Clinic Dialysis Services provides all HD in the Mayo Clinic Health System, a comprehensive integrated healthcare network for 395,000 residents in southeastern Minnesota, northern Iowa, and southwestern Wisconsin, through 8 community-based outpatient HD facilities as previously described (11,12). This study included patients ≥ 18 years of age who initiated chronic outpatient HD between January 1, 2001 and May 31, 2013 (n = 1357) and remained on dialysis ≥ 30 days (n = 1187), and who underwent ECHO examination at Mayo Clinic ≤ 1 month prior or ≤ 3 months following HD initiation (n = 654).…”

Section: Methodsmentioning

confidence: 99%

Echocardiography Criteria for Structural Heart Disease in Patients With End-Stage Renal Disease Initiating Hemodialysis

Hickson

Negrotto

Onuigbo

et al. 2016

Journal of the American College of Cardiology

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Background Cardiovascular disease among hemodialysis (HD) patients is linked to poor outcomes. The Acute Dialysis Quality Initiative Workgroup proposed echocardiographic (ECHO) criteria for structural heart disease (SHD) in dialysis patients. The association of SHD with patient-important outcomes is not well defined. Objectives We determined prevalence of ECHO determined SHD and its association with survival among incident HD patients. Methods We analyzed patients initiating chronic HD from 2001-2013 who underwent ECHO ≤ 1 month prior to or ≤ 3 months following HD initiation (n = 654). Results Mean patient age was 66 ± 16 years, and 60% of patients were male. ECHO findings that met 1 or more and ≥ 3 of the new criteria were discovered in 87% and 54% of patients, respectively. Over a median of 2.4 years, 415 patients died: 108 (26%) died within 6 months. Five-year mortality was 62%. Age- and gender-adjusted structural heart disease variables associated with death were left ventricular ejection fraction (LEVF) ≤ 45% (HR 1.48, CI 1.20-1.83) and right ventricular (RV) systolic dysfunction (HR 1.68, CI 1.35-2.07). An additive of higher death risk included LVEF ≤ 45% and RV systolic dysfunction rather than neither (HR 2.04, CI 1.57-2.67; p = 0.53 for test for interaction). Following adjustment for age, gender, race, diabetic kidney disease, and dialysis access, RV dysfunction was independently associated with death (HR 1.66; CI 1.34-2.06; p < 0.001). Conclusions SHD was common in our hemodialysis study population, and RV systolic dysfunction independently predicted mortality.

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“…Patients were then cross-referenced with ICD9 and billing codes for end-stage renal disease 585.6, dialysis V56.8, renal dialysis status or dependence on renal dialysis V45.11, or chronic kidney disease codes (n=159). The final cohort (n=12) was restricted to patients receiving maintenance HD therapy within one of Mayo Clinic Dialysis Services’ 8 dialysis units from January 1, 2002 to May 31, 2014 as previously described [26,27]. Electronic chart reviews were conducted to confirm study eligibility and collect study data.…”

Section: Methodsmentioning

confidence: 99%

Tolerability and Healthcare Utilization in Maintenance Hemodialysis Patients Undergoing Treatment for Tuberculosis-Related Conditions

Hamadah

Beaulieu

Wilson

et al. 2016

Nephron

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Background: The incidence of tuberculosis (TB) in end-stage renal disease is significantly higher than that in the general population. Among those with kidney dysfunction, anti-TB treatment is associated with increased side effects, but the effect on healthcare utilization is unknown. Methods/Aim: To assess patient-reported symptoms, adverse effects and describe changes in healthcare utilization patterns during treatment for TB, we conducted a case series (n = 12) of patients receiving maintenance hemodialysis (HD) from Mayo Clinic Dialysis Services and concurrent drug therapy for TB from January 2002 through May 2014. Healthcare utilization (hospitalizations and emergency department (ED) visits independent of hospital admission) was compared before and during treatment. Results: Patients were treated for latent (n = 7) or active (n = 5) TB. The majority of patients with latent disease were treated with isoniazid (n = 5, 71%), while active-disease patients received a 4-drug regimen. Adverse effects were reported in 83% of patients. Compared to measurements prior to drug initiation, serum albumin and dialysis weights were similar at 3 months. Commonly reported anti-TB drug toxicities were described. More than half (58%) of the patients were hospitalized at least once. No ED or hospital admissions occurred in the period prior to drug therapy, but healthcare utilization increased during treatment in the latent disease group (hospitalization rate per person-month: pre 0 vs. post 1). Conclusions: Among HD patients, anti-TB therapy is associated with frequently reported symptoms and increased healthcare utilization. Among this subset, patients receiving treatment for latent disease may be those with greatest increase in healthcare use. Careful monitoring and early complication detection may help optimize medication adherence and minimize hospitalizations.

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Risk factors for hospitalization among older, incident haemodialysis patients

Cited by 26 publications

References 29 publications

Predictors of Outpatient Kidney Function Recovery Among Patients Who Initiate Hemodialysis in the Hospital

Predictors of Outpatient Kidney Function Recovery Among Patients Who Initiate Hemodialysis in the Hospital

Echocardiography Criteria for Structural Heart Disease in Patients With End-Stage Renal Disease Initiating Hemodialysis

Tolerability and Healthcare Utilization in Maintenance Hemodialysis Patients Undergoing Treatment for Tuberculosis-Related Conditions

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