Hospitalization for initiation of maintenance hemodialysis.

Mahendra Agraharkar, Mario A. Martinez, Yong Fang Kuo, Tejinder S. Ahuja

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: Recent data on complications of hemodialysis (HD) is lacking. With advancement in dialysis technology the incidence of complications such as dialysis disequilibrium syndrome (DDS) has decreased. Notwithstanding these improvements many patients with end-stage renal disease (ESRD) continue to be hospitalized solely for initiation of hemodialysis. This study was undertaken to assess if such admissions are justified and also to determine incidence and predictors of complications of HD during initiation. METHODS: Medical records of adult patients (>18 years) initiated on maintenance hemodialysis from January 1st, 1998 through December 31st, 2000 at our institution were reviewed. The demographics of the patients, cause of renal failure, creatinine clearance, type of vascular access, comorbidities, serum chemistries, ultrafiltration (UF) rate and indications for initiating dialysis were noted. Intradialytic complications were retrieved from the dialysis flow sheets. RESULTS: Of the 240 patients reviewed, 18.3% developed complications during initiation of dialysis, and none was severe. Hypotension and leg cramps were the most frequent complications. The patients who developed hypotension and cramps were significantly older than those with no complications, 57.7 +/- 14.9 (mean +/- SD) years versus 52.3 +/- 14.8 years, respectively (p = 0.02). The increment of age significantly influenced the complication rate [odds ratio (OR): 1.03, 95% confidence interval (CI) 1.01-1.05 (p = 0.03)], and so did hematocrit (HCT) (OR: 1.07, 95% CI 1.01-1.13). Multivariate analysis using age and hematocrit as continuous variables revealed that the older patients with anemia had a significantly higher risk of developing HD related complications than younger patients with anemia (OR: 1.05, 95% CI 1.01-1.09 at HCT of 24%, and OR: 1.03, 95% CI 1.00-1.06 at HCT 27%). When patients were stratified by hematocrit level, older patients with hematocrit <27% had higher risk of complications and the risk increased with increasing age [complication rate (HCT <27%): age <40 = 0%, age 40-64 = 11.7%, age >65 = 25%, p < 0.016]. CONCLUSION: Although very few, hypotension and muscle cramps were the main complications during initiation of HD. Older patients with anemia are prone for these complications although no physician intervention was necessary. Hospitalization solely for initiation of maintenance dialysis is not necessary and the additional cost from such admissions cannot be justified.

Original languageEnglish (US)
JournalNephron. Clinical practice
Volume97
Issue number2
StatePublished - 2004

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Renal Dialysis
Hospitalization
Maintenance
Hematocrit
Dialysis
Muscle Cramp
Odds Ratio
Hypotension
Confidence Intervals
Anemia
Incidence
Ultrafiltration
Chronic Kidney Failure
Medical Records
Renal Insufficiency
Blood Vessels
Comorbidity
Creatinine
Leg
Multivariate Analysis

Cite this

Agraharkar, M., Martinez, M. A., Kuo, Y. F., & Ahuja, T. S. (2004). Hospitalization for initiation of maintenance hemodialysis. Nephron. Clinical practice, 97(2).

Hospitalization for initiation of maintenance hemodialysis. / Agraharkar, Mahendra; Martinez, Mario A.; Kuo, Yong Fang; Ahuja, Tejinder S.

In: Nephron. Clinical practice, Vol. 97, No. 2, 2004.

Research output: Contribution to journalArticle

Agraharkar, M, Martinez, MA, Kuo, YF & Ahuja, TS 2004, 'Hospitalization for initiation of maintenance hemodialysis.', Nephron. Clinical practice, vol. 97, no. 2.
Agraharkar, Mahendra ; Martinez, Mario A. ; Kuo, Yong Fang ; Ahuja, Tejinder S. / Hospitalization for initiation of maintenance hemodialysis. In: Nephron. Clinical practice. 2004 ; Vol. 97, No. 2.
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abstract = "BACKGROUND: Recent data on complications of hemodialysis (HD) is lacking. With advancement in dialysis technology the incidence of complications such as dialysis disequilibrium syndrome (DDS) has decreased. Notwithstanding these improvements many patients with end-stage renal disease (ESRD) continue to be hospitalized solely for initiation of hemodialysis. This study was undertaken to assess if such admissions are justified and also to determine incidence and predictors of complications of HD during initiation. METHODS: Medical records of adult patients (>18 years) initiated on maintenance hemodialysis from January 1st, 1998 through December 31st, 2000 at our institution were reviewed. The demographics of the patients, cause of renal failure, creatinine clearance, type of vascular access, comorbidities, serum chemistries, ultrafiltration (UF) rate and indications for initiating dialysis were noted. Intradialytic complications were retrieved from the dialysis flow sheets. RESULTS: Of the 240 patients reviewed, 18.3{\%} developed complications during initiation of dialysis, and none was severe. Hypotension and leg cramps were the most frequent complications. The patients who developed hypotension and cramps were significantly older than those with no complications, 57.7 +/- 14.9 (mean +/- SD) years versus 52.3 +/- 14.8 years, respectively (p = 0.02). The increment of age significantly influenced the complication rate [odds ratio (OR): 1.03, 95{\%} confidence interval (CI) 1.01-1.05 (p = 0.03)], and so did hematocrit (HCT) (OR: 1.07, 95{\%} CI 1.01-1.13). Multivariate analysis using age and hematocrit as continuous variables revealed that the older patients with anemia had a significantly higher risk of developing HD related complications than younger patients with anemia (OR: 1.05, 95{\%} CI 1.01-1.09 at HCT of 24{\%}, and OR: 1.03, 95{\%} CI 1.00-1.06 at HCT 27{\%}). When patients were stratified by hematocrit level, older patients with hematocrit <27{\%} had higher risk of complications and the risk increased with increasing age [complication rate (HCT <27{\%}): age <40 = 0{\%}, age 40-64 = 11.7{\%}, age >65 = 25{\%}, p < 0.016]. CONCLUSION: Although very few, hypotension and muscle cramps were the main complications during initiation of HD. Older patients with anemia are prone for these complications although no physician intervention was necessary. Hospitalization solely for initiation of maintenance dialysis is not necessary and the additional cost from such admissions cannot be justified.",
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AU - Martinez, Mario A.

AU - Kuo, Yong Fang

AU - Ahuja, Tejinder S.

PY - 2004

Y1 - 2004

N2 - BACKGROUND: Recent data on complications of hemodialysis (HD) is lacking. With advancement in dialysis technology the incidence of complications such as dialysis disequilibrium syndrome (DDS) has decreased. Notwithstanding these improvements many patients with end-stage renal disease (ESRD) continue to be hospitalized solely for initiation of hemodialysis. This study was undertaken to assess if such admissions are justified and also to determine incidence and predictors of complications of HD during initiation. METHODS: Medical records of adult patients (>18 years) initiated on maintenance hemodialysis from January 1st, 1998 through December 31st, 2000 at our institution were reviewed. The demographics of the patients, cause of renal failure, creatinine clearance, type of vascular access, comorbidities, serum chemistries, ultrafiltration (UF) rate and indications for initiating dialysis were noted. Intradialytic complications were retrieved from the dialysis flow sheets. RESULTS: Of the 240 patients reviewed, 18.3% developed complications during initiation of dialysis, and none was severe. Hypotension and leg cramps were the most frequent complications. The patients who developed hypotension and cramps were significantly older than those with no complications, 57.7 +/- 14.9 (mean +/- SD) years versus 52.3 +/- 14.8 years, respectively (p = 0.02). The increment of age significantly influenced the complication rate [odds ratio (OR): 1.03, 95% confidence interval (CI) 1.01-1.05 (p = 0.03)], and so did hematocrit (HCT) (OR: 1.07, 95% CI 1.01-1.13). Multivariate analysis using age and hematocrit as continuous variables revealed that the older patients with anemia had a significantly higher risk of developing HD related complications than younger patients with anemia (OR: 1.05, 95% CI 1.01-1.09 at HCT of 24%, and OR: 1.03, 95% CI 1.00-1.06 at HCT 27%). When patients were stratified by hematocrit level, older patients with hematocrit <27% had higher risk of complications and the risk increased with increasing age [complication rate (HCT <27%): age <40 = 0%, age 40-64 = 11.7%, age >65 = 25%, p < 0.016]. CONCLUSION: Although very few, hypotension and muscle cramps were the main complications during initiation of HD. Older patients with anemia are prone for these complications although no physician intervention was necessary. Hospitalization solely for initiation of maintenance dialysis is not necessary and the additional cost from such admissions cannot be justified.

AB - BACKGROUND: Recent data on complications of hemodialysis (HD) is lacking. With advancement in dialysis technology the incidence of complications such as dialysis disequilibrium syndrome (DDS) has decreased. Notwithstanding these improvements many patients with end-stage renal disease (ESRD) continue to be hospitalized solely for initiation of hemodialysis. This study was undertaken to assess if such admissions are justified and also to determine incidence and predictors of complications of HD during initiation. METHODS: Medical records of adult patients (>18 years) initiated on maintenance hemodialysis from January 1st, 1998 through December 31st, 2000 at our institution were reviewed. The demographics of the patients, cause of renal failure, creatinine clearance, type of vascular access, comorbidities, serum chemistries, ultrafiltration (UF) rate and indications for initiating dialysis were noted. Intradialytic complications were retrieved from the dialysis flow sheets. RESULTS: Of the 240 patients reviewed, 18.3% developed complications during initiation of dialysis, and none was severe. Hypotension and leg cramps were the most frequent complications. The patients who developed hypotension and cramps were significantly older than those with no complications, 57.7 +/- 14.9 (mean +/- SD) years versus 52.3 +/- 14.8 years, respectively (p = 0.02). The increment of age significantly influenced the complication rate [odds ratio (OR): 1.03, 95% confidence interval (CI) 1.01-1.05 (p = 0.03)], and so did hematocrit (HCT) (OR: 1.07, 95% CI 1.01-1.13). Multivariate analysis using age and hematocrit as continuous variables revealed that the older patients with anemia had a significantly higher risk of developing HD related complications than younger patients with anemia (OR: 1.05, 95% CI 1.01-1.09 at HCT of 24%, and OR: 1.03, 95% CI 1.00-1.06 at HCT 27%). When patients were stratified by hematocrit level, older patients with hematocrit <27% had higher risk of complications and the risk increased with increasing age [complication rate (HCT <27%): age <40 = 0%, age 40-64 = 11.7%, age >65 = 25%, p < 0.016]. CONCLUSION: Although very few, hypotension and muscle cramps were the main complications during initiation of HD. Older patients with anemia are prone for these complications although no physician intervention was necessary. Hospitalization solely for initiation of maintenance dialysis is not necessary and the additional cost from such admissions cannot be justified.

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