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Risk factors for hospitalization among older, incident haemodialysis patients
Author(s) -
Schoonover Kimberly L,
Hickson LaTonya J,
Norby Suzanne M,
Hogan Marie C,
Chaudhary Sanjay,
Albright Robert C,
Dillon John J,
McCarthy James T,
Williams Amy W
Publication year - 2013
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12129
Subject(s) - medicine , dialysis , hazard ratio , psychological intervention , hemodialysis , emergency medicine , dialysis catheter , pediatrics , intensive care medicine , confidence interval , psychiatry
Aims The number of elderly persons with end‐stage renal disease is increasing with many requiring hospitalizations. This study examines the causes and predictors of hospitalization in older haemodialysis patients. Methods We reviewed hospitalizations of older (≥65 years) incident chronic haemodialysis patients initiating therapy between 1 J anuary 2007 and 31 D ecember 2009 under the care of a single M idwestern U nited S tates dialysis provider. Results Of 125 patients, the mean age was 76 ± 7 years and 72% were male. At first dialysis, 68% used a central venous catheter ( CVC ) and 51% were in the hospital. Mean follow‐up was 1.8 ± 1.0 years. At least one hospitalization occurred in 89 (71%) patients and half of all patients were hospitalized once within the first 223 days. Total hospital admission rate was 1.48 per patient year with hospital days totalling 8.54 days per patient year. The three most common reasons for first admission were cardiac (33%), infection (18%) and gastrointestinal (12%). Predictors of future hospitalization included the first dialysis occurring in hospital (hazard ratios ( HR ) 2.1, 95% CI 1.4–3.3, P = 0.0005) and the use of a CVC at first haemodialysis ( HR 2.6, CI 1.6–4.4, P < 0.0001). Conclusion Hospitalizations are common in older incident haemodialysis patients. Access preparation and overall burden of illness leading to the initial hospitalization appear to play a role. Identification of additional factors associated with hospitalization will allow for focused interventions to reduce hospitalization rates and increase the value of care.