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Hospitalizations in Patients on Chronic Hemodialysis (HD)
Author(s) -
Saad E,
Servilla KS,
Tzamaloukas AH
Publication year - 2003
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1046/j.1492-7535.2003.01228.x
Subject(s) - medicine , diabetes mellitus , dialysis , hemodialysis , obstructive uropathy , hyperkalemia , hypoglycemia , hypervolemia , surgery , urinary system , endocrinology , blood volume
We analyzed causes, duration, and outcomes of hospitalization in patients on HD followed in a dialysis unit. We identified a total of 42 patients (40 men, 2 women), 34–93 (66.3 ± 12.8) years of age. The causes of renal failure included diabetic nephropathy in 23 patients (54.8%), hypertensive nephrosclerosis in 7 (16.7%), primary renal disease in 7 (16.7%), obstructive uropathy in 3 (7.1%) and unknown illness in 2 patients (4.7%). Over a 12‐month period, these patients had 96 hospitalizations (2.3 per pt). Duration of hospitalization was 29.9 ± 47.4 days per pt annually. Nine subjects (21.4%, age 71.4 ± 12.5 years, diabetes 66.7%) had no hospitalization, while 8 subjects (19.0%, age 61.0 ± 19.0 years, diabetes 75.5%) had ≥ 4 hospitalizations. Hospitalizations were more frequent (2.8 vs. 2.0 annually) and marginally longer (37.9 ± 51.2 vs. 20.2 ± 29.4 days annually per pt, p = 0.06)) in patients with than those without diabetes. Among the admissions, 30 (31.3%, 8.9 days annually per pt) were due to vascular access complications (clotting, infections − 2 with endocarditis‐, etc), 16 (16.7%, 9.0 days annually per pt) were due to leg gangrene (8 amputations), 13 (13.5%, 1.5 days annually per pt) were due to cardiac causes or stroke, 12 (12.5%, 2.3 days annually per pt) were due to hypervolemia or metabolic derangements (hypoglycemia, hyperglycemia, hyperkalemia), 8 (8.3%, 2.6 days annually per pt) were due to elective surgical procedures, 7 (7.3%, 4.1 days annually per pt) were due to respiratory disease, and 10 (10.4%, 1.6 days annually per pt) were due to miscellaneous causes including psychiatric disease (3 admissions), warfarin overdose (2 admissions), liver abscess, urinary tract infection, enteric polyps, metastatic prostate cancer, and terminal care. Four patients died during hospitalization from cardiac causes (2), respiratory failure (1) and uremia after stopping dialysis (1). Hospitalizations are frequent and prolonged in patients on HD, particularly those with diabetic nephropathy. Vascular access complications and ischemic events in the legs, rather than cardiac causes, are the major causes of hospitalization in HD patients.