Hospitalizations before and after initiation of chronic hemodialysis
ABSTRACT Hospitalization rate is high in patients on chronic hemodialysis (HD). We investigated whether initiation of HD changes the rate and length of hospitalization. We analyzed hospitalizations in HD patients in one hospital over 15 years. We compared annual rate and length of hospitalizations, both presented as mean (95% confidence interval [CI]) between the pre-HD and HD period. Three hundred ninety-two patients, 98% men, 59% diabetic, and 66.3 ± 11.2 years old at the onset of HD, had 1016 hospitalizations in the pre-HD period (60.0 ± 42.9 months) and 1627 hospitalizations in the HD period (32.5 ± 25.9 months). Higher values were found in the HD than the pre-HD period for rate, (pre-HD 0.557 [95% CI 0.473-0.611], HD 2.198 [95% CI 1.997-2.399] admissions/[patient-year], P<0.001) and length (pre-HD 4.63 [95% CI 3.71-5.55], HD 28.07 [95% CI 23.55-32.59] days/patient-year], P<0.001) of hospitalizations for all causes, cardiac disease, infections, vascular access, peripheral vascular disease, metabolic disturbances, gastrointestinal diseases, and miscellaneous conditions, mainly respiratory illness and malignancy. Similar differences were found when we compared the year before and the year after the start of HD. Diabetics had higher all cause rate and length of hospitalizations than non-diabetics in the pre-HD and HD periods. The rate and length of hospitalizations was higher in the HD than the pre-HD period for both HD-specific conditions and conditions encountered in both HD and general populations. Study of factors specific to HD that may affect these conditions should constitute the first step toward improving the morbidity of patients on HD.
SourceAvailable from: Emmanuel Agaba[Show abstract] [Hide abstract]
ABSTRACT: To identify factors associated with the development of hyperkalemia in patients with chronic kidney disease (CKD), we analyzed conditions present during episodes of hyperkalemia in two patients with insulindependent diabetes mellitus who had elevated serum potassium concentration ([K]) in ≥ 20% of the blood samples during both the prehemodialysis and the hemodialysis period. In both patients, conditions causing derangements in the internal potassium balance (exchanges of potassium between the intracellular and the extracellular compartment), including severe hyperglycemia (serum glucose concentration ≥ 400 mg/dL) and catabolic illnesses, were present in ≥ 75% of the instances of simple hyperkalemia ([K] ≥ 5.1 mmol/L) and almost all of the instances of severe hyperkalemia ([K] ≥ 6.0 mmol/L) during both the pre-hemodialysis and the hemodialysis periods. Derangements of the internal potassium balance, many of which are potentially preventable, can be a major cause of hyperkalemia in patients with CKD before or after starting chronic hemodialysis. Careful analysis of the conditions associated with and potentially causing hyperkalemia in CKD patients is imperative for both treatment and prevention purposes.02/2014; DOI:10.7759/cureus.162
[Show abstract] [Hide abstract]
ABSTRACT: 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 hemodialysis patients. We reviewed hospitalizations of older (≥65 years) incident chronic hemodialysis patients initiating therapy between January 1, 2007 and December 31, 2009 under the care of a single Midwestern United States dialysis provider. 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 totaling 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 (HR 2.1, 95% CI 1.4-3.3, p=0.0005) and the use of a CVC at first HD (HR 2.6, CI 1.6-4.4, p <.0001). Hospitalizations are common in older incident hemodialysis 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.Nephrology 07/2013; 18(11). DOI:10.1111/nep.12129 · 1.86 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Background: The utility of glycated hemoglobin (HbA1c) and glycated albumin (GA) in diabetic dialysis patients remains unknown. GA was previously associated with all-cause hospitalization and patient survival. Relationships between GA, HbA1c, and casual plasma glucose (PG) with cause-specific cardiovascular (CV) disease, infectious disease (ID), and vascular access- (VA) related hospitalization rates and length of stay (LOS) were assessed. Methods: 444 prevalent diabetic dialysis patients had monthly PG, quarterly GA, and all HbA1c values recorded for 2.33 years; hospitalizations within 17 and 30 days of testing were evaluated. Best-fit, time-dependent Cox models were constructed in unadjusted, case-mix-adjusted (age, sex, race, BMI, diabetes duration, dialysis vintage), and case-mix- plus lab-adjusted (hemoglobin, albumin, phosphorus) models. Results: Mean ± SD diabetes duration was 18.5 ± 10.8 years and dialysis vintage 2.9 ± 2.6 years. In fully adjusted models, CV hospitalization rates were associated with increasing GA (HR 1.32; 95% CI 1.11-1.57; p = 0.002 at 17 days; HR 1.21; p = 0.02 at 30 days) and PG (HR 1.10; 95% CI 1.02-1.17; p = 0.01 at 17 days; HR 1.07; p = 0.03 at 30 days), not HbA1c (HR 1.24; 95% CI 0.89-1.73; p = 0.21 at 17 days; HR 1.26; p = 0.10 at 30 days). LOS for CV admissions was positively associated with GA (HR 1.18; 95% CI 1.01-1.39; p = 0.03), not PG (HR 1.04; 95% CI 0.99-1.10; p = 0.15) or HbA1c (HR 1.03; 95% CI 0.92-1.15; p = 0.21). Admissions due to ID and VA complications (and LOS) did not correlate with these assays. Conclusions: Improved glycemic control based on GA and PG predicted CV-related hospitalizations; GA also predicted CV hospitalization LOS. HbA1c did not predict cause-specific hospitalizations in dialysis populations.American Journal of Nephrology 11/2012; 36(5):488-496. DOI:10.1159/000343920 · 2.65 Impact Factor