Risk Factors for Hospitalization in Well-Dialyzed Chronic Hemodialysis Patients

Abstract

Background/Aims: Hemodialysis (HD) patients are hospitalized more frequently than patients with other chronic diseases, averaging 11.5 hospital days/patient/year. Hospital costs attributable to renal failure in the US exceed $2 billion per year. The present healthcare climate continues to force dialysis providers to focus on these issues in order to optimize patient care while limiting cost. Methods: We used a novel method for analyzing hospitalization risk, a multiple-event Cox proportional hazards model, to identify factors that influenced hospitalization in a HD unit population over a two-year period. This model allows individual patients to contribute multiple failure events to the model while controlling for the serial dependency of events. Results: 178 HD patients were retrospectively examined. There were 381 hospitalizations during the study period, averaging out to 1.9 hospitalizations and 10.5 hospital days/patient-year. Substance abuse and diabetes conveyed the largest risks for hospitalization (diabetes RR: 2.09; substance abuse RR: 2.24) in the study cohort, exposing the necessity for examining practice patterns and behavioral interventions as means for improving HD patient care. Conclusion: Despite the small numbers of patients in this single-center HD population, the model achieved adequate statistical power. Therefore, it has the potential to serve as a continuous quality improvement (CQI) tool in particular HD patient sub-groups, or in individual HD units.

Hospitalizations before and after initiation of chronic hemodialysis

“…Although various aspects of hospitalization in dialysis patients have been addressed, [1][2][3][4][5][6][9][10][11][12][13] comparisons of hospitalizations before and after initiation of dialysis are scarce. The main finding of this study was that the rate and length of hospitalizations both overall and for several individual categories of morbid conditions was higher in the HD than the pre-HD period.…”

Cardioprotection in the ESRD Population: How Do We Get There?

“…In order to perform the chart abstraction, a case list was obtained from each of the participating dialysis facilities. The following were required in order to be included in the case list: (1) Medicare beneficiary, (2) age > 18 years, (3) HD dependent for > 6 months, and (4) presence of CVD as defined by a history of heart failure, prior MI, hypertension, or coronary artery disease.…”

“…Even after controlling for race, gender, age, and the presence of diabetes, patients on hemodialysis (HD) and peritoneal dialysis are 10 to 20 times more likely to die from CVD compared to the general population [2]. ESRD patients, on average, have more hospital admissions per year and longer lengths of stay compared to non-ESRD patients [3]. ESRD patients are seven times more likely to be hospitalized for heart failure, and three times more likely to be hospitalized for myocardial infarction (MI), compared to patients with other chronic health conditions [4].…”

Hospital admissions in elderly patients on chronic hemodialysis

“…In a report from the United States Renal Data System (USRDS), while the overall rate of hospital admissions in HD patients did not appear to change significantly between 1993 and 2006, there was a decrease in this rate from 2.111 to 2.039 admissions per patient year for patients 70-79 years old and from 2.234 to 2.132 admissions per patient year for patients C80 years old [11]. A multivariate analysis identified diabetes mellitus and drug abuse, but not age, as predictors of hospitalization in HD patients [12]. In another study, advanced age had no effect on the rate of admissions for vascular access complications, but was associated with an increased risk of hospital admissions for non-vascular access-related conditions in HD patients [13].…”