Change in Vascular Access and Hospitalization Risk in Long-Term Hemodialysis Patients

Lacson, Eduardo; Wang, Weiling; Lazarus, J. Michael; Hakim, Raymond M.

doi:10.2215/cjn.08961209

Cited by 62 publications

(52 citation statements)

References 38 publications

(25 reference statements)

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“…Not surprisingly, low serum albumin was a powerful predictor of 30-day readmission. Catheter vascular access and intradialytic hypotension, two important prognostic factors in the outpatient setting, were also predictive of readmission (19,20). Intradialytic hypotension is associated with end organ ischemia of the heart, gut, and brain and plausibly places patients at risk for conditions leading to hospital readmission (21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

Predictors of 30-Day Hospital Readmission among Maintenance Hemodialysis Patients: A Hospital’s Perspective

Flythe

Katsanos

et al. 2016

CJASN

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Background and objectives Over 35% of patients on maintenance dialysis are readmitted to the hospital within 30 days of hospital discharge. Outpatient dialysis facilities often assume responsibility for readmission prevention. Hospital care and discharge practices may increase readmission risk. We undertook this study to elucidate risk factors identifiable from hospital-derived data for 30-day readmission among patients on hemodialysis.Design, setting, participants, & measurements Data were taken from patients on maintenance hemodialysis discharged from University of North Carolina Hospitals between May of 2008 and June of 2013 who received inpatient hemodialysis during their index hospitalizations. Multivariable logistic regression models with 30-day readmission as the dependent outcome were used to identify readmission risk factors. Models considered variables available at hospital admission and discharge separately.Results Among 349 patients, 112 (32.1%) had a 30-day hospital readmission. The discharge (versus admission) model was more predictive of 30-day readmission. In the discharge model, malignancy comorbid condition (odds ratio [OR], 2.08; 95% confidence interval [95% CI], 1.04 to 3.11), three or more hospitalizations in the prior year (OR, 1.97; 95% CI, 1.06 to 3.64), $10 outpatient medications at hospital admission (OR, 1.69; 95% CI, 1.00 to 2.88), catheter vascular access (OR, 1.82; 95% CI, 1.01 to 3.65), outpatient dialysis at a nonuniversity-affiliated dialysis facility (OR, 3.59; 95% CI, 2.03 to 6.36), intradialytic hypotension (OR, 3.10; 95% CI, 1.45 to 6.61), weekend discharge day (OR, 1.82; 95% CI, 1.01 to 3.31), and serum albumin ,3.3 g/dl (OR, 4.28; 95% CI, 2.37 to 7.73) were associated with higher readmission odds. A decrease in prescribed medications from admission to discharge (OR, 0.20; 95% CI, 0.08 to 0.51) was associated with lower readmission odds. Findings were robust across different model-building approaches.Conclusions Models containing discharge day data had greater predictive capacity of 30-day readmission than admission models. Identified modifiable readmission risk factors suggest that improved medication education and improved transitions from hospital to community may potentially reduce readmissions. Studies evaluating targeted transition programs among patients on dialysis are needed.

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Section: Discussionmentioning

confidence: 99%

Predictors of 30-Day Hospital Readmission among Maintenance Hemodialysis Patients: A Hospital’s Perspective

Flythe

Katsanos

et al. 2016

CJASN

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“…Numerous studies over the past two decades have shown associations between CVC use and higher risk for adverse clinical outcomes in patients undergoing in-center HD (10)(11)(12)(13)(14)(20)(21)(22). However, there are important ways in which home HD differs from in-center HD that may substantially alter the risks associated with CVC use.…”

Section: Discussionmentioning

confidence: 99%

“…In patients undergoing in-center HD, use of CVCs is associated with greater risk of adverse clinical outcomes, including higher rates of mortality and hospitalization, at least in part because of greater incidence of infection-related complications (10)(11)(12)(13)(14). In contrast, there are only limited data examining the association of vascular access type with clinical outcomes for patients undergoing home HD, individuals in whom incidence of nosocomial infection may be lower (15).…”

Section: Introductionmentioning

confidence: 99%

Association of Vascular Access Type with Mortality, Hospitalization, and Transfer to In-Center Hemodialysis in Patients Undergoing Home Hemodialysis

Rivara

Soohoo

Streja

et al. 2016

Clinical Journal of the American Society of Nephrology

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“…In an observational study of 79,545 patients, conversion from CVC access to a working fistula or graft was associated with 30% decreases in both hospitalization and mortality (6,8). In a meta-analysis of 545,441 patients, CVC use was associated with 53% higher risk of death and more than twice as many fatal infections compared with working AVFs (26).…”

Section: Discussionmentioning

confidence: 99%

“…Using an AVF or even an arteriovenous graft (AVG) rather than a central venous catheter (CVC) reduces the risks of infection, hospitalizations, and mortality. However, .80% of Americans initiate HD with CVCs (1-3), despite evidence showing that failure to transition to a fistula strongly predicts poor outcomes and increased costs of care (4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Peripherally Inserted Central Catheters and Hemodialysis Outcomes

McGill

Ruthazer²,

Meyer

et al. 2016

CJASN

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Background and objectives Use of peripherally inserted central catheters has expanded rapidly, but the consequences for patients who eventually require hemodialysis are undefined.Design, setting, participants, & measurements Our national, population-based analysis included 33,918 adult Medicare beneficiaries from the US Renal Data System who initiated hemodialysis with central venous catheters as their sole vascular access in 2010 and 2011. We used linked Medicare claims to identify peripherally inserted central catheter exposures and evaluate the associations of peripherally inserted central catheter placement with transition to working arteriovenous fistulas or grafts and patient survival using a Cox model with timedependent variables.Results Among 33,918 individuals initiating hemodialysis with a catheter as sole access, 12.6% had received at least one peripherally inserted central catheter. Median follow-up was 404 days (interquartile range, 103-680 days). Among 6487 peripherally inserted central catheters placed, 3435 (53%) were placed within the 2 years before hemodialysis initiation, and 3052 (47%) were placed afterward. Multiple peripherally inserted central catheters were placed in 30% of patients exposed to peripherally inserted central catheters. Recipients of peripherally inserted central catheters were more likely to be women and have comorbid diagnoses and less likely to have received predialysis nephrology care. After adjustment for clinical and demographic factors, peripherally inserted central catheters placed before or after hemodialysis initiation were independently associated with lower likelihoods of transition to any working fistula or graft (hazard ratio for prehemodialysis peripherally inserted central catheter, 0.85; 95% confidence interval, 0.79 to 0.91; hazard ratio for posthemodialysis peripherally inserted central catheter, 0.81; 95% confidence interval, 0.73 to 0.89).Conclusions Peripherally inserted central catheter placement was common and associated with adverse vascular access outcomes. Recognition of potential long-term adverse consequences of peripherally inserted central catheters is essential for clinicians caring for patients with CKD.

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Change in Vascular Access and Hospitalization Risk in Long-Term Hemodialysis Patients

Cited by 62 publications

References 38 publications

Predictors of 30-Day Hospital Readmission among Maintenance Hemodialysis Patients: A Hospital’s Perspective

Predictors of 30-Day Hospital Readmission among Maintenance Hemodialysis Patients: A Hospital’s Perspective

Association of Vascular Access Type with Mortality, Hospitalization, and Transfer to In-Center Hemodialysis in Patients Undergoing Home Hemodialysis

Peripherally Inserted Central Catheters and Hemodialysis Outcomes

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