Noninvasive Interventions to Decrease Hospitalization and Associated Costs for Pediatric Patients Receiving Hemodialysis

Goldstein, Stuart L.; Smith, Caroline J.; Currier, Helen

doi:10.1097/01.asn.0000076077.05508.7e

Cited by 47 publications

(46 citation statements)

References 17 publications

(17 reference statements)

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“…Monitoring of a hematocrit-guided ultrafiltration algorithm lowered hospitalization for fluid overload and hypertension among pediatric HD patients (27). Cardiovascular admissions are higher on the day following the longest interdialytic interval in HD patients (28,29); therefore, alternative dialysis schedules deserve further study to determine their impact on hospitalization and readmission (30,31).…”

Section: Discussionmentioning

confidence: 99%

Readmission within 30 days of Hospital Discharge among Children Receiving Chronic Dialysis

Springel

Laskin

Furth

2014

Clinical Journal of the American Society of Nephrology

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Background and objectives The hospital admission rate for children receiving chronic dialysis has been increasing over the last decade. Approximately one third of patients with ESRD age 0-19 years are readmitted to the hospital within 30 days of discharge. The objective of this study was to examine hospital readmissions among a cohort of children receiving chronic dialysis to identify factors associated with higher rates of 30-day readmission.Design, settings, participants, & measurements A retrospective cohort of index admissions was developed among chronic dialysis patients age 3 months to 17 years at free-standing children's hospitals reporting information to the Pediatric Hospital Information System between January 2006 and November 30, 2010, and followed until December 31, 2010. The primary outcome was any-cause 30-day readmission, and the secondary outcome was 30-day readmission for a cause similar to that of the index hospitalization.Results In this cohort, 25% of hospital admissions were followed by a readmission within 30 days. Children older than 2 years of age had a lower odds of readmission (odds ratio [OR], 0.6; 95% confidence interval [95% CI], 0.5 to 0.8). Those receiving hemodialysis had a higher risk of readmission (OR, 1.2; 95% CI, 1.0 to 1.4), and admissions .14 days were also more likely to be followed by a readmission (OR, 1.5; 95% CI, 1.1 to 2.0). Approximately 50% of the readmissions were for a similar diagnosis as the index admission; however, the specific admitting diagnosis was not associated with readmission.Conclusions A significant number of admissions among children receiving long-term dialysis are followed by readmission within 30 days. Further investigation is required to reduce the high rate of readmissions in these children.

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Section: Discussionmentioning

confidence: 99%

Readmission within 30 days of Hospital Discharge among Children Receiving Chronic Dialysis

Springel

Laskin

Furth

2014

Clinical Journal of the American Society of Nephrology

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“…Studies among HD patients in both adults and children suggest that managing intradialytic relative plasma volume (RPV) may reduce the number of hospital admissions caused by fluid overload, 104,105 may improve BP control, and may decrease hypotension-associated dialysis symptoms. 106 It is possible that the latter benefit is, in part, related to diminished use of antihypertensive medication.…”

Section: Dry Weight and Outcomesmentioning

confidence: 99%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

147

156

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Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. Hypertension is common among patients with ESRD. In this review, we discuss the diagnosis, epidemiology, and management of hypertension among dialysis patients. We also review areas of existing controversies and briefly discuss the issue of hypertension in pediatric dialysis patients. EPIDEMIOLOGYThe prevalence, treatment, and control of hypertension among people on hemodialysis (HD) have used varying definitions to diagnose hypertension. The epidemiology differs based on how BP is measured: either before and after dialysis or using ambulatory BP recordings. Epidemiology with Routine BP MeasurementsThe prevalence of hypertension (defined as 1-week average predialysis systolic BP [SBP] measurements .150 mmHg or diastolic BP [DBP].85 mmHg or the use of antihypertensive medications) was 86% among 2535 clinically stable adult HD patients participating in a multicenter trial. 1 Among hypertensive patients, 12% did not receive antihypertensive drugs, 58% were treated but not controlled, and only 30% were controlled. The use of antihypertensive drugs has been reported to vary from 59% to 83%. [2][3][4][5] Furthermore, even among children on long-term HD, similar findings have been reported. 6 Several studies have confirmed greater antihypertensive drug use to be associated with poorer control. 7,8 It should be noted that antihypertensive drug use per se do not lead to worse BP control; in the absence of adequate volume control, increasing antihypertensive drug use may simply reflect difficult-to-control BP. Epidemiology Using Ambulatory BP MeasurementsThe prevalence of hypertension (defined by either a 44-hour interdialytic ambulatory BP of $135/85 mmHg or the prescription of any antihypertensive agent) was 86% among 369 chronic HD patients. 8 Although hypertension was being treated with antihypertensive drugs in 89% of patients, it was adequately controlled only in 38%. The independent determinants of poor control were the use of antihypertensive drugs and an expanded extracellular volume state. If patients were volume overloaded, nearly 80% became hypertensive when medications were Published online ahead of print. Publication date available at www.jasn.org.

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“…By serially measuring hematocrit in the blood tubing using an external optical sensor, CritLine detects intravascular volume changes that occur with ultrafiltration or fluid administration during hemodialysis (6,7). Therefore, it is proposed that intravascular volume monitoring using Crit-Line may serve as a prospective management tool for fluid removal and be superior to clinical judgment (7)(8)(9)(10)(11).…”

Section: Study Rationale Design Monitoring and Interventionsmentioning

confidence: 99%

Intradialytic Blood Volume Monitoring in Ambulatory Hemodialysis Patients

Reddan

Szczech

Hasselblad

et al. 2005

Journal of the American Society of Nephrology

181

168

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Complications related to inadequate volume management are common during hemodialysis. This trial tested the hypothesis that availability of an intradialytic blood volume monitoring (IBVM) device improves fluid removal, reducing morbidity. A six-center, randomized trial with 6 mo of intervention comparing IBVM using Crit-Line versus conventional clinical monitoring was conducted. The average rate of non-access-related hospitalizations was compared across treatment groups using Poisson regression. Mortality analysis used the Kaplan Meier method. A total of 227 patients were randomized to Crit-Line, and 216 were randomized to conventional monitoring. Both groups had similar baseline characteristics. During the study, no differences in weight, BP, or number of dialysis-related complications were observed. There were 120 and 81 non-access-related hospitalizations in the Crit-Line and conventional monitoring groups. The adjusted risk ratio for non-access-related and access-related hospitalization was 1.61 (95% confidence interval 1.15 to 2.25; P ‫؍‬ 0.01) and 1.52 (95% confidence interval 1.02 to 2.28; P ‫؍‬ 0.04) for the Crit-Line monitoring group. Mortality was 8.7% in the Crit-Line monitoring group and 3.3% in the conventional group (P ‫؍‬ 0.021). Standardized mortality ratios comparing the Crit-Line and conventional monitoring groups to the prevalent hemodialysis population were 0.77 (NS) and 0.26 (P < 0.001). Hospitalization rates were 1.51 and 1.03 events/yr in the Crit-Line and standard monitoring groups, compared with 2.01 for the prevalent hemodialysis population. IBVM was associated with higher nonvascular and vascular access-related hospitalizations and mortality compared with conventional monitoring. The atypically low hospitalization and mortality rates for the conventional monitoring group suggest that these findings should be generalized to the US hemodialysis population with caution.

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Noninvasive Interventions to Decrease Hospitalization and Associated Costs for Pediatric Patients Receiving Hemodialysis

Cited by 47 publications

References 17 publications

Readmission within 30 days of Hospital Discharge among Children Receiving Chronic Dialysis

Readmission within 30 days of Hospital Discharge among Children Receiving Chronic Dialysis

Assessment and Management of Hypertension in Patients on Dialysis

Intradialytic Blood Volume Monitoring in Ambulatory Hemodialysis Patients

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