Race/Ethnicity, Age, and Risk of Hospital Admission and Length of Stay during the First Year of Maintenance Hemodialysis

Abstract

Background and objectives Although patients undergoing maintenance hemodialysis have exceptionally high hospitalization rates, the risk factors for hospitalizations are unclear. This study sought to examine hospitalization rates among hemodialysis patients in the United States according to both race/ethnicity and age.Design, setting, participants, & measurements US Renal Data System data on 563,281 patients beginning maintenance hemodialysis between 1995 and 2009 were analyzed. Rates of hospital admission and number of hospital days for all-cause and cause-specific hospitalizations during the first year of dialysis were compared among blacks, whites, and Hispanics in the entire cohort and subgroups stratified by age.Results After multiple adjustments, compared with whites, Hispanics overall had lower rates of both all-cause hospital days (adjusted rate ratio [aRR], 0.91; 95% confidence interval [95% CI], 0.90 to 0.93; P,0.001) and hospital admissions (aRR, 0.89; 95% CI, 0.88 to 0.90; P,0.001), whereas blacks had a lower rate of all-cause admissions (aRR, 0.95; 95% CI, 0.94 to 0.96; P,0.001). The racial/ethnic differences, however, varied by age. Hispanics exhibited the lowest rates of hospital days and admissions for all age groups#70 years, but those .80 years had higher rates than their white counterparts. The adjusted black-to-white rate ratios exhibited a U-shaped pattern with age, with higher rates for blacks in the younger and older age groups. Hospitalization rates for dialysisrelated infections were markedly higher in blacks and Hispanics than whites, which were consistent in all age groups for blacks (aRRs for hospital days ranged from 1.09 to 1.36) and all ages.60 years for Hispanics (aRRs ranged from 1.20 to 1.38).Conclusions There are significant racial/ethnic differences in hospitalization rates within first year of dialysis, which are not consistent across the age groups and also differ by causes of hospitalization. Overall, blacks and Hispanics had lower rates of all-cause hospital admissions than whites. However, younger and older blacks and older Hispanics were at greatest risk.

Patient Satisfaction in Tertiary Private Hospitals in Najran, Kingdom of Saudi Arabia

“…This implicates that a greater number of people hospitalized in Najran do not have health insurance. This is parallel to the study of Yan et al, 13 where they found that patients without insurance have a higher risk for hospitalization. Table 2 represents the level of satisfaction of patients for all variables.…”

Interstate Variation in Receipt of Nephrologist Care in US Patients Approaching ESRD

“…The lower rate of receiving nephrologist care by the younger black patients with CKD, as described in this study, may be responsible, in part, for their poor outcomes reported in the literature (44)(45)(46)(47). Novel strategies aimed at improving pre-ESRD care for younger black patients and implemented both nationally and at the state level could have far-reaching effects.…”

An Update on Inpatient Hypertension Management

“…Much more common in practice, though, are patients who present with prerenal azotemia or acute tubular necrosis due to various insults [36]. End-stage kidney disease patients are also at very high risk for hospitalization due to hypertensive urgency/emergency even after initiation of hemodialysis [37,38]. Post-acute management of patients with acute kidney injury focuses on avoidance of nephrotoxic medications including iodinated contrast, maintaining adequate urinary output with judicious use of diuretic medications, and control of BP [39].…”