Inpatient hemodialysis initiation

reasons, risk factors and outcomes.

Deidra C. Crews, Bernard G. Jaar, Laura C. Plantinga, Hania Kassem, Nancy E. Fink, Neil R. Powe

Research output: Contribution to journalArticle

19 Citations (Scopus)

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.

Original languageEnglish (US)
JournalNephron. Clinical practice
Volume114
Issue number1
DOIs
StatePublished - 2010
Externally publishedYes

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Renal Dialysis
Inpatients
Hospitalization
Nephrology
Confidence Intervals
Social Support
Comorbidity
Outpatients
Uremia
Incidence
Dialysis
Cohort Studies
Prospective Studies
Costs and Cost Analysis
Mortality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Inpatient hemodialysis initiation : reasons, risk factors and outcomes. / Crews, Deidra C.; Jaar, Bernard G.; Plantinga, Laura C.; Kassem, Hania; Fink, Nancy E.; Powe, Neil R.

In: Nephron. Clinical practice, Vol. 114, No. 1, 2010.

Research output: Contribution to journalArticle

Crews, Deidra C. ; Jaar, Bernard G. ; Plantinga, Laura C. ; Kassem, Hania ; Fink, Nancy E. ; Powe, Neil R. / Inpatient hemodialysis initiation : reasons, risk factors and outcomes. In: Nephron. Clinical practice. 2010 ; Vol. 114, No. 1.
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