Effect of Temporary Catheter and Late Referral on Hospitalization and Mortality During the First Year of Hemodialysis Treatment

Gonçalves, Elsa Alídia Petry; Andreoli, Maria Cláudia Cruz; Watanabe, Renato; Freitas, Maria Cecília S.; Pedrosa, Alessandra Coelho; Manfredi, Sílvia Regina; Draibe, Sérgio Antônio; Cendoroglo, Miguel; Canziani, María Eugênia Fernandes

doi:10.1111/j.1525-1594.2004.00016.x

Cited by 26 publications

(21 citation statements)

References 22 publications

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“…Moreover, a higher incidence of vascular access infection was related to longer periods of hospitalization (6,10) .…”

Section: Discussionmentioning

confidence: 99%

“…Data in the literature have shown high morbidity and mortality rates among patients who develop BSI related to the use of CVCs for hemodialysis (4)(5) . Consequently, there is a rise in both hospital costs and microbial resistance (1,6) . Therefore, the prevention of such BSI needs to be considered a priority matter in programs for infection control and hospital quality control assessment.…”

Section: Among the Microorganisms Responsible Formentioning

confidence: 99%

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Incidence of bloodstream infection among patients on hemodialysis by central venous catheter

Grothe

Belasco

Bittencourt

et al. 2010

Rev. Latino-Am. Enfermagem

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were methicillin-sensitive and 23 were methicillin-resistant. Complications related to BSI included 35 cases of septicemia and 27 cases of endocarditis, of which 15 cases progressed to death. The incidence of BSI among these patients was shown to be very high, and this BSI progressed rapidly to the condition of severe infection with a high mortality rate. Incidencia de infección de la corriente sanguínea em los pacientes sometidos a hemodiálisis por catéter venoso centralEl objetivo de este estudio fue evaluar la incidencia y los factores de riesgo de infección resistentes. Entre las complicaciones relacionadas a la ICS, hubo 35 casos de septicemia y 27 casos de endocarditis, de los cuales 15 resultaron en muerte. La incidencia de ICS en este grupo de pacientes se mostró bastante elevada así como su progresión para cuadros infecciosos de gran magnitud y de muerte.

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“…Moreover, a higher incidence of vascular access infection was related to longer periods of hospitalization (6,10) .…”

Section: Discussionmentioning

confidence: 99%

Section: Among the Microorganisms Responsible Formentioning

confidence: 99%

Incidence of bloodstream infection among patients on hemodialysis by central venous catheter

Grothe

Belasco

Bittencourt

et al. 2010

Rev. Latino-Am. Enfermagem

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“…Infections are also known to be more frequent and severe in dialysis patients than in the general population. [8][9][10][11][12]23,[26][27][28] Most studies found that the Hemodialysis International 2010; 14:S14-S21 S18 use of temporary or permanent HD catheters carries clear clinical disadvantages. High frequency and severity of pneumonias in HD populations have been found in a National registry study.…”

Section: Discussionmentioning

confidence: 99%

Death during hospitalization in patients on chronic hemodialysis

Behl

Sun

Agaba

et al. 2010

Hemodialysis International

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Mortality from various causes is higher in patients on chronic hemodialysis (HD) than in the general population. There is evidence suggesting that some of the deaths in HD patients are preventable. To identify potentially preventable causes of death, we analyzed deaths that occurred in HD patients during hospitalization over a period of 15 years. We performed a retrospective cohort analysis of 410 patients on HD for at least 6 months between 1995 and 2009 (included), who had all their hospitalizations in the same hospital. The patients were classified into 3 groups: Those who died during hospitalization (group A, n=120), those who died away from the hospital (group B, n=135), and those who were alive at the end of the observation period (group C, n=155). Continuous variables were compared between groups by the Kruskall-Wallis statistic. Logistic regression was used to identify predictors of dying during the observation period and predictors of death in the hospital. For the whole HD group of 410 patients, only 9 (2.2%) were women. 59% of the patients had diabetes mellitus. Age at the onset of HD was 65.8 ± 11.5 years and the duration of HD was 34.4 ± 27.9 months. Group A patients had a higher annual rate and duration of hospitalization and a higher Charlson comorbidity index than either of the other 2 groups, and, in comparison with patients in group C, were older at the end of observation and had a shorter duration of HD. Cardiac disease (19.2%), vascular access complications (18.3%), peripheral vascular disease (16.7%), infections (15.8%), trauma (11.7%), central nervous system disease (7.5%), respiratory failure (4.2%), malignancy (3.3%), and gastrointestinal disease (3.3%) were the causes of the last hospitalization in group A. Compared with the patients who died during hospitalization without discontinuing HD, group A patients who discontinued HD had a longer duration of their last hospitalization (52.7 ± 77.7 vs. 14.3 ± 23.8 days, P<0.001). Discontinuation of HD occurred in 80% of the hospitalizations for respiratory failure, 75% of the hospitalizations for malignancy, 57% of the hospitalizations for trauma, and 56% of the hospitalizations for central nervous system disease. Logistic regression identified a high Charlson index, advanced age, and short duration of HD as predictors of death, and an absence of diabetes, high Charlson index, prolonged annual duration of hospitalization, and short distance of the patient's domicile from the dialysis unit as predictors of death in the hospital. A substantial number of hospitalizations leading to the death of HD patients are caused by potentially preventable conditions, including vascular access complications, peripheral vascular disease, and trauma. Implementation of measures preventing these hospitalizations is a worthwhile undertaking.

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“…The association between LR and poor outcome may be related to other factors, such as uremia itself. Moreover, a recent study demonstrated that LR was the main risk factor for mortality during the first year of dialysis, even when considering the risk of infection associated with TVCs, the main cause of death in the HD population [37]. …”

Section: Discussionmentioning

confidence: 99%

Late Referral to a Nephrologist Increases the Risk of Uremia-Related Cardiac Hypertrophy in Patients on Hemodialysis

Shin¹,

Kim²,

Chung³

et al. 2007

Nephron Clin Pract

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Background: The prognosis and outcome of patients with end-stage renal disease are related to the quality of predialysis care and the timing of referral. Late referral (LR) has been correlated with more frequent hospital admissions, malnutrition and cardiovascular mortality after hemodilaysis (HD) is started. Methods: We investigated the effects of LR on cardiac hypertrophy, uremia-related metabolic risk factors and mortality in patients on HD. A baseline echocardiography was performed in 119 patients on HD, 67 of whom were early referrals (ER, referred more than 3 months before the start of HD) and 52 were LR (referred less than 3 months before the start of HD; median (range): 22.5 (4–120) vs. 1.0 (0–3) months, respectively). Results: The survival curves showed a higher mortality rate in the LR patients than in the ER patients (log rank, p = 0.004). More patients in the LR group died of cardiovascular disease compared to the ER patients (p = 0.04). The plasma levels of albumin were significantly lower (p < 0.05), and the intact parathyroid hormone (iPTH) and log C-reactive protein (log CRP) were significantly higher in the LR patients compared to the ER patients (p < 0.05 and p < 0.001, respectively). The LR patients, especially nonsurvivors, showed greater impairment of systolic cardiac function and more concentric left ventricular hypertrophy (LVH) than ER patients, as determined by interventricular septal thickness (p < 0.001), left ventricular posterior wall thickness (p < 0.001), relative wall thickness (p = 0.02), and the left ventricular mass index (LVMi, p < 0.001). Interestingly, the duration of the pre-HD treatment, after referral, was positively associated with the plasma albumin (r = 0.229; p = 0.01) and negatively associated with the log CRP (r = –0.350; p < 0.001), iPTH (r = –0.309; p = 0.001) and LVMi (r = –0.268; p = 0.004). Multiple linear regression analysis also demonstrated that the log CRP and iPTH as well as the LR were independently associated with LVMi in the HD patients (p < 0.05). Conclusions: The results of this study demonstrated that the LR HD patients were at an increased risk for more cardiovascular related mortality, severe concentric LVH and systolic dysfunction accompanied by inflammatory and malnutrition indices, as well as with increased iPTH levels. In the LR patients, the more severe LVH associated with severe inflammatory indices, as well as the higher iPTH levels, may be one of the causes of LR-related mortality.

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Effect of Temporary Catheter and Late Referral on Hospitalization and Mortality During the First Year of Hemodialysis Treatment

Cited by 26 publications

References 22 publications

Incidence of bloodstream infection among patients on hemodialysis by central venous catheter

Incidence of bloodstream infection among patients on hemodialysis by central venous catheter

Death during hospitalization in patients on chronic hemodialysis

Late Referral to a Nephrologist Increases the Risk of Uremia-Related Cardiac Hypertrophy in Patients on Hemodialysis

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