Open AccessPre-dialysis acute care hospitalizations and clinical outcomes in dialysis patients
Author(s) -
Silvi Shah,
Karthikeyan Meganathan,
Annette Christianson,
Anthony Leonard,
Charuhas V. Thakar
Publication year - 2019
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0209578
Subject(s) - medicine , dialysis , hemodialysis , odds ratio , peritoneal dialysis , kidney disease , confidence interval , central venous catheter , end stage renal disease , intensive care medicine , surgery , catheter
Background Patients with chronic kidney disease (CKD), a precursor of end stage renal disease (ESRD), face an increasing burden of hospitalizations. Although mortality on dialysis is highest during the first year, the impact of pre-dialysis acute hospitalizations on clinical outcomes in dialysis patients remains unknown. Methods We evaluated 170,897 adult patients who initiated dialysis between 1/1/2010 and 12/31/2014 with linked Medicare claims from the United States Renal Data System. Using logistic regression models, we examined the association of 2-year pre-dialysis hospitalization on the primary outcome of 1-year all-cause mortality. Secondary outcomes included 90-day mortality, type of initial dialysis modality and type of vascular access at hemodialysis initiation. Results Mean age was 72.7 ± 11.0 years. In the study sample, 76.0% of patients had at least one pre-dialysis hospitalization. Compared to patients with no pre-dialysis hospitalization, the adjusted 1-year mortality was higher with pre-dialysis cardiovascular related hospitalization (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.57–1.68), infection related hospitalization (OR, 1.51; CI, 1.45–1.57), both cardiovascular and infection hospitalization (OR, 1.91; CI, 1.83–1.99), and neither-cardiovascular nor-infection hospitalization (OR, 1.23; CI, 1.19–1.27). Additionally, the adjusted odds of hemodialysis vs. peritoneal dialysis as the initial dialysis modality were higher, whereas adjusted odds to initiate hemodialysis with an arteriovenous access vs. central venous catheter were lower in patients with any type of hospitalization. Conclusion Pre-dialysis hospitalization is an independent predictor of 1-year mortality in dialysis patients. Reducing the risk of pre-dialysis hospitalization may provide opportunities to improve quality of care in ESRD.