Hospitalizations of Chronic Dialysis Patients: A National Study in China

Abstract

Background Patients receiving chronic dialysis are usually with multiple comorbidities and at high-risk for hospitalization, which lead to tremendous healthcare resources utilization. This study aims to explore the characteristics of hospitalizations among chronic dialysis patients in China. Methods Hospital admissions from January 2013 to December 2015 were extracted from a national inpatient database in China. Chronic dialysis, including hemodialysis and peritoneal dialysis, were identified according to inpatients discharge records and International Classification of Diseases-10 (ICD-10) codes. The primary kidney disease, causes of admissions, modalities of dialysis, and comorbidities were analyzed. Multivariable Logistic regression model was used to assess the association of patient characteristics with multiple hospitalizations per year. Results Altogether, 266,636 hospitalizations from 124,721 chronic dialysis patients were included in the study. The mean age was 54.46±15.63 years and 78.29% of them were receiving hemodialysis. The leading cause of hospitalizations was dialysis access-related, including dialysis access creation (25.06%) and complications of access (21.09%). The following causes were non-access surgery (1.89%), cardiovascular disease (1.66%), and infectious diseases (1.43%). One fourth of the patients were hospitalized more than once per year. Multivariate Logistic regression models indicated that the primary kidney disease of diabetic kidney disease (odds ratio [OR]: 1.16, 95% confidence interval [CI]: 1.11-1.22) or hypertensive nephropathy (OR: 1.33, 95% CI: 1.27-1.40), coronary heart disease (OR: 1.09, 95% CI: 1.05-1.14), cancer (OR: 1.21, 95% CI: 1.13-1.30), or modality of peritoneal dialysis (OR: 2.67, 95% CI: 2.59-2.75) were risk factors for multiple hospitalizations. Conclusion Our study described characteristics and revealed the burden of hospitalizations of chronic dialysis patients in China. These findings highlight the importance of effective and efficient management strategies to reduce the high burden of hospitalization in dialysis population.