Hemodialysis interval and its association with emergency care and mortality

Chien, Ching‐Wen; Huang, Chi‐Jung; Chao, Zi-Hao; Huang, Song-Kong; Chen, Pei‐En; Tung, Tao‐Hsin

doi:10.1097/md.0000000000014816

Cited by 9 publications

(6 citation statements)

References 32 publications

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“…DN is caused by long-term abnormal glucose metabolism, which results in decreased glomerular filtration rate and glomerular sclerosis, and thus leads to damage to renal functions, causing great harm to the health of patients [ 11 ]. At present, maintenance hemodialysis can be used to effectively prolong the survival time of patients; however, long-term hemodialysis leads to the occurrence of cardiovascular and cerebrovascular events and increases the risk of death [ 12 ]. In this study, the incidence of cardiovascular and cerebrovascular events in 144 patients with DN receiving maintenance hemodialysis was 43.75%, which is basically consistent with the results of Mei et al [ 13 ] and Luo et al [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Establishment of a Nomogram Model for Predicting Cardiovascular and Cerebrovascular Events in Diabetic Nephropathy Patients Receiving Maintenance Hemodialysis

Liu

Yan

Niu

et al. 2022

Applied Bionics and Biomechanics

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Objective. The objective of this study is to explore the risk factors of cardiovascular and cerebrovascular events (CCE) in patients with diabetic nephropathy (DN) receiving maintenance hemodialysis, and to establish a nomogram model on this basis. Method. 144 patients with DN receiving maintenance hemodialysis from February 2020 to February 2021 were selected and followed up for 12 months. They were divided into the occurrence and nonoccurrence groups according to whether CCE occurred. The multivariate logistic regression analysis was used to analyze the influencing factors of CCE, and a predictive nomogram model was established. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive effect of the nomogram model. The Hosmer-Lemeshow method was used to test the calibration degree. Results. Among the patients, 63 patients (43.75%) encountered CCE. Multivariate logistic regression analysis showed that age >60 years old, history of CCE, dialysis age >12 months, systolic blood pressure >140 mmHg, blood phosphorus level >1.5 mmol/L, triglyceride (TG) level >2.30 mmol/l, adiponectin (ADPN) level <5 mg/L, high-sensitivity-C-reactive protein (hs-CRP) level >10 mg/L, hemoglobin (Hb) level <120 g/L, serum creatinine (SCr) level >720 μmol/L, and albumin (ALB) level <40 g/L were independent risk factors for CCE. Based on the above independent risk factors, a nomogram model of CCE was created. ROC curve analysis showed that the area under curve for predicting CCE was 0.881 (95% CI: 0.833~0.919), indicating that the nomogram model had great predictive effect. The Hosmer-Lemeshow method showed that the calibration curve was in good agreement with the standard curve. Conclusion. Age, history of CCE, dialysis age, systolic blood pressure and serum phosphorus, and TG, ADPN, hs-CRP, Hb, SCr, and ALB levels are all influencing factors for the occurrence of CCE in patients with DN receiving maintenance hemodialysis, and the nomogram model has a great predictive effect on CCE.

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Section: Discussionmentioning

confidence: 99%

Establishment of a Nomogram Model for Predicting Cardiovascular and Cerebrovascular Events in Diabetic Nephropathy Patients Receiving Maintenance Hemodialysis

Liu

Yan

Niu

et al. 2022

Applied Bionics and Biomechanics

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“…Fifty-one percent (689 of 1351) of ED encounters for an ACSC resulted in a hospital admission compared with 28.8% (9396 of 32 678) for a non-ACSC-related ED encounter (P < .001). Hospital length of stay was slightly shorter for ACSC-related ED encounters resulting in admission than for non-ACSC-related admissions (median [IQR], (5 [3-9] days vs 7 [4][5][6][7][8][9][10][11][12][13][14][15] days). Differences in the top 10 diagnoses most responsible for the ED encounter (patient-and encounter-level analyses) for the first ED encounter and any ED encounter stratified by ACSC status are provided in eTables 2 and 3 in Supplement 1.…”

Section: Resultsmentioning

confidence: 99%

“…People with kidney failure receive emergency care for a variety of health issues that occur both with and as a result of their underlying kidney disease . Studies have noted temporal trends in increased acute care use during specific periods, such as after long interdialytic intervals and shortly before and after initiating dialysis . However, the medical reasons prompting ED visits are broadly distributed across many diagnoses that can be but are not necessarily related to kidney failure or the need for dialysis .…”

Section: Introductionmentioning

confidence: 99%

“… 7 Studies have noted temporal trends in increased acute care use during specific periods, such as after long interdialytic intervals and shortly before and after initiating dialysis. 5 , 8 , 9 , 10 , 11 However, the medical reasons prompting ED visits are broadly distributed across many diagnoses that can be but are not necessarily related to kidney failure or the need for dialysis. 12 Previous research by our group has found that 6% of all ED encounters among people with chronic kidney disease were for conditions commonly attributed to advanced kidney disease that are potentially preventable through early identification and intervention (eg, hyperkalemia, volume overload).…”

Section: Introductionmentioning

confidence: 99%

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Emergency Department Use Among Adults Receiving Dialysis

Ronksley,

Scory,

McRae

et al. 2024

JAMA Netw Open

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ImportancePeople with kidney failure receiving maintenance dialysis visit the emergency department (ED) 3 times per year on average, which is 3- to 8-fold more often than the general population. Little is known about the factors that contribute to potentially preventable ED use in this population.ObjectiveTo identify the clinical and sociodemographic factors associated with potentially preventable ED use among patients receiving maintenance dialysis.Design, Setting, and ParticipantsThis cohort study used linked administrative health data within the Alberta Kidney Disease Network to identify adults aged 18 years or older receiving maintenance dialysis (ie, hemodialysis or peritoneal dialysis) between April 1, 2010, and March 31, 2019. Patients who had been receiving dialysis for more than 90 days were followed up from cohort entry (defined as dialysis start date plus 90 days) until death, outmigration from the province, receipt of a kidney transplant, or end of study follow-up. The Andersen behavioral model of health services was used as a conceptual framework to identify variables related to health care need, predisposing factors, and enabling factors. Data were analyzed in March 2024.Main Outcomes and MeasuresRates of all-cause ED encounters and potentially preventable ED use associated with 4 kidney disease–specific ambulatory care–sensitive conditions (hyperkalemia, heart failure, volume overload, and malignant hypertension) were calculated. Multivariable negative binomial regression models were used to examine the association between clinical and sociodemographic factors and rates of potentially preventable ED use.ResultsThe cohort included 4925 adults (mean [SD] age, 60.8 [15.5] years; 3071 males [62.4%]) with kidney failure receiving maintenance hemodialysis (3183 patients) or peritoneal dialysis (1742 patients) who were followed up for a mean (SD) of 2.5 (2.0) years. In all, 3877 patients had 34 029 all-cause ED encounters (3100 [95% CI, 2996-3206] encounters per 1000 person-years). Of these, 755 patients (19.5%) had 1351 potentially preventable ED encounters (114 [95% CI, 105-124] encounters per 1000 person-years). Compared with patients with a nonpreventable ED encounter, patients with a potentially preventable ED encounter were more likely to be in the lowest income quintile (38.8% vs 30.9%; P &lt; .001); to experience heart failure (46.8% vs 39.9%; P = .001), depression (36.6% vs 32.5%; P = .03), and chronic pain (60.1% vs 54.9%; P = .01); and to have a longer duration of dialysis (3.6 vs 2.6 years; P &lt; .001). In multivariable regression analyses, potentially preventable ED use was higher for younger adults (incidence rate ratio [IRR], 1.69 [95% CI, 1.33-2.15] for those aged 18 to 44 years) and patients with chronic pain (IRR, 1.35 [95% CI, 1.14-1.61]), greater material deprivation (IRR, 1.57 [95% CI, 1.16-2.12]), a history of hyperkalemia (IRR, 1.31 [95% CI, 1.09-1.58]), and historically high ED use (ie, ≥3 ED encounters in the prior year; IRR, 1.46 [95% CI, 1.23-1.73).Conclusions and RelevanceIn this study of adults receiving maintenance dialysis in Alberta, Canada, among those with ED use, 1 in 5 had a potentially preventable ED encounter; reasons for such encounters were associated with both psychosocial and medical factors. The findings underscore the need for strategies that address social determinants of health to avert potentially preventable ED use in this population.

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“…According to our results, admission was predominantly on Monday and Tuesday with a long interval between last hemodialysis and admission. Chien et al reported that patients with regular hemodialysis schedules on Monday–Wednesday–Friday needed emergency treatment most frequently on Mondays, whereas those with schedules on Tuesday–Thursday–Saturday needed it most frequently on Tuesdays [8]. A total of 48 (40.7%) in 118 events were observed on Mondays and Tuesdays in their report.…”

Section: Discussionmentioning

confidence: 99%

Infrequent use of nighttime dialysis for emergency admission due to worsening heart failure in patients on maintenance hemodialysis

et al. 2021

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In the emergency admission due to worsening heart failure (HF) in patients on maintenance hemodialysis, emergent dialysis may be indicated, which increases personnel expenses. To clarify the characteristics and in‐hospital management of the patients, we conducted a multicenter retrospective study including 142 patients on maintenance hemodialysis emergently admitted for worsening HF (71.6 ± 9.2 years, 69.0% male, 44.4% HF with preserved [≥50%] ejection fraction). The interval between last hemodialysis and admission was long (median 55 h), suggesting that fluid accumulation triggered HF events. Although most patients (73.9%) were admitted in the nighttime (5 p.m. to 9 a.m.), only 17.9% of them needed nighttime dialysis and were managed medically until the first in‐hospital dialysis, with the use of noninvasive positive pressure ventilation in 45.1% and oxygen supplementation in 95.8%. While patients on hemodialysis with worsening HF were frequently admitted in the nighttime, nighttime dialysis was indicated in a limited population.

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Hemodialysis interval and its association with emergency care and mortality

Cited by 9 publications

References 32 publications

Establishment of a Nomogram Model for Predicting Cardiovascular and Cerebrovascular Events in Diabetic Nephropathy Patients Receiving Maintenance Hemodialysis

Establishment of a Nomogram Model for Predicting Cardiovascular and Cerebrovascular Events in Diabetic Nephropathy Patients Receiving Maintenance Hemodialysis

Emergency Department Use Among Adults Receiving Dialysis

Infrequent use of nighttime dialysis for emergency admission due to worsening heart failure in patients on maintenance hemodialysis

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