Hospitalizations before and after initiation of chronic hemodialysis

Abstract

Hospitalization rate is high in patients on chronic hemodialysis (HD). We investigated whether initiation of HD changes the rate and length of hospitalization. We analyzed hospitalizations in HD patients in one hospital over 15 years. We compared annual rate and length of hospitalizations, both presented as mean (95% confidence interval [CI]) between the pre-HD and HD period. Three hundred ninety-two patients, 98% men, 59% diabetic, and 66.3 ± 11.2 years old at the onset of HD, had 1016 hospitalizations in the pre-HD period (60.0 ± 42.9 months) and 1627 hospitalizations in the HD period (32.5 ± 25.9 months). Higher values were found in the HD than the pre-HD period for rate, (pre-HD 0.557 [95% CI 0.473-0.611], HD 2.198 [95% CI 1.997-2.399] admissions/[patient-year], P<0.001) and length (pre-HD 4.63 [95% CI 3.71-5.55], HD 28.07 [95% CI 23.55-32.59] days/patient-year], P<0.001) of hospitalizations for all causes, cardiac disease, infections, vascular access, peripheral vascular disease, metabolic disturbances, gastrointestinal diseases, and miscellaneous conditions, mainly respiratory illness and malignancy. Similar differences were found when we compared the year before and the year after the start of HD. Diabetics had higher all cause rate and length of hospitalizations than non-diabetics in the pre-HD and HD periods. The rate and length of hospitalizations was higher in the HD than the pre-HD period for both HD-specific conditions and conditions encountered in both HD and general populations. Study of factors specific to HD that may affect these conditions should constitute the first step toward improving the morbidity of patients on HD.

Glycated Albumin, Not Hemoglobin A1c, Predicts Cardiovascular Hospitalization and Length of Stay in Diabetic Patients on Dialysis

“…WFSM has an out-patient dialysis access center, likely reducing the frequency of hospitalizations for non-functioning accesses. Other studies reported annual hospitalization rates of 0.24 for ID, 0.30 for CV, and 0.63 for VA-related disorders [51]. Significant associations between GA and PG with CV hospitalizations and LOS, despite lower than expected CV admission rates, strengthen the prognostic capability of these assays.…”

“…The mortality rate in our cohort during the study period was lower than the national average, supporting lower rates of CV hospitalizations [18]. Kassam et al [51] reported that patients on dialysis with DM had significantly higher hospitalization rates for peripheral vascular disease (PVD) than did those without DM. We did not analyze PVD-related hospitalizations separately (e.g .…”

“…Patients on dialysis have higher hospitalization rates and LOS relative to those without ESRD [35,51]. Hospitalization rates in dialysis patients with DM are nearly 2-fold higher than in those without DM [51].…”

Hyperkalemia in two patients with diabetes mallitus and chronic kidney disease. Role of disrupted internal potassium balance

“…Table 1 shows age at initiation of dialysis, duration of follow-up pre-HD and during the HD period, and annual hospitalization rates, plus average days of hospitalization per annum. The table also shows the 95% confidence interval (CI) of the corresponding values for a control group comprised of all other diabetic men treated in the same dialysis unit over the same period [7]. The control group was used only for comparison of morbidity with the two patients presented.…”

“…The rates and lengths of hospitalizations exceeded the corresponding upper limits of the 95% CIs intervals of the control group in both the pre-HD and HD periods in both patients. [7]. The numbers in the Controls column show mean (95% Confidence Interval)…”