Inpatient Hemodialysis Initiation: Reasons, Risk Factors and Outcomes

Original Paper

Inpatient Hemodialysis Initiation: Reasons, Risk Factors and Outcomes
Deidra C. Crewsa, Bernard G. Jaara-d, Laura C. Plantingae, Hania S. Kassemd, Nancy E. Finka, b, Neil R. Powee, f

aDepartment of Medicine, Johns Hopkins University School of Medicine,
bDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health,
cNephrology Center of Maryland, and
dDepartment of Medicine, Good Samaritan Hospital, Baltimore, Md., and
eDepartment of Medicine, University of California San Francisco, and
fDepartment of Medicine, San Francisco General Hospital, San Francisco, Calif., USA

Address of Corresponding Author

Nephron Clin Pract 2010;114:c19-c28 (DOI: 10.1159/000245066)

goto top of page Key Words

* End-stage renal disease
* Hospitalization
* Late referral
* Mortality
* Social support

goto top of page Abstract

Background/Aims: Inpatient initiation of chronic hemodialysis is considered undesirable because of cost and possible harms of hospitalization. We examined the patient characteristics and outcomes associated with inpatient initiation. Methods: In a prospective cohort study of incident dialysis patients, the independent association of inpatient hemodialysis initiation with patient outcomes was assessed in multivariable analyses with adjustment for patient characteristics and propensity for inpatient initiation. Results: A total of 410 of 652 (63%) hemodialysis patients began as inpatients; uremia and volume overload were the most commonly documented reasons. Compared to outpatients, inpatients were more likely to be unmarried, report less social support, have multiple comorbidities and be referred to a nephrologist 4 months or less prior to initiation. Inpatient initiation was protective for subsequent all-cause hospitalization (incidence rate ratio (IRR) = 0.92, confidence interval (CI) 0.89-0.94); this was most pronounced among those who had the highest propensity for inpatient initiation (IRR = 0.66, CI 0.56-0.78), including those referred late to nephrology. Similar results were found for infectious hospitalization. Mortality [hazard ratio = 1.03, CI 0.82-1.30] and cardiovascular events were not significantly different for inpatients versus outpatients. Conclusion: Inpatient hemodialysis initiation has a protective association with hospitalization among those patients referred late to nephrology, with multiple comorbidities and/or little social support.

Copyright © 2009 S. Karger AG, Basel

goto top of page Author Contacts

Deidra C. Crews, MD
Division of Nephrology, Department of Medicine
Johns Hopkins University School of Medicine
1830 E. Monument Street, Suite 416, Baltimore, MD 21205 (USA)
Tel. +1 410 955 5268, Fax +1 410 955 0485, E-Mail dcrews1@jhmi.edu

goto top of page Article Information

Some of the data reported here have been supplied by the United States Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the NCRR or NIH.

Received: April 6, 2009
Accepted: June 2, 2009
Published online: October 9, 2009
Number of Print Pages : 10
Number of Figures : 1, Number of Tables : 3, Number of References : 36

Journal Home
Journal Content
Guidelines
Editorial Board
Aims and Scope
Subscriptions
Medline Abstract (ID 19816040)
Download Citation

For non-native English speakers and international authors who would like assistance with their writing before submission, we suggest American Journal Experts for their scientific editing service.

http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ArtikelNr=245066&Ausgabe=251928&ProduktNr=228539