Risk factors for hospitalization among older, incident haemodialysis patients

Kimberly L. Schoonover, LaTonya Hickson, Suzanne M. Norby, Marie C Hogan, Sanjay Chaudhary, Robert C. Albright, John J. Dillon, James T. McCarthy, Amy W. Williams

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Aims 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 haemodialysis patients. Methods We reviewed hospitalizations of older (≥65 years) incident chronic haemodialysis patients initiating therapy between 1 January 2007 and 31 December 2009 under the care of a single Midwestern United States dialysis provider. Results 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 totalling 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 (hazard ratios (HR) 2.1, 95% CI 1.4-3.3, P = 0.0005) and the use of a CVC at first haemodialysis (HR 2.6, CI 1.6-4.4, P < 0.0001). Conclusion Hospitalizations are common in older incident haemodialysis 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. Summary at a Glance This study identifies potential factors associated with the frequency and timing of hospitalizations in older patients commencing dialysis, including use of a CVC and initial dialysis when hospitalized. Hospitalizations were mainly because of cardiac and infectious aetiology.

Original languageEnglish (US)
Pages (from-to)712-717
Number of pages6
JournalNephrology
Volume18
Issue number11
DOIs
StatePublished - 2013

Fingerprint

Renal Dialysis
Hospitalization
Dialysis
Central Venous Catheters
Midwestern United States
Cost of Illness
Chronic Kidney Failure
Infection

Keywords

  • arteriovenous fistula
  • cardiovascular disease
  • dialysis access
  • geriatric nephrology
  • mortality

ASJC Scopus subject areas

  • Nephrology
  • Medicine(all)

Cite this

Schoonover, K. L., Hickson, L., Norby, S. M., Hogan, M. C., Chaudhary, S., Albright, R. C., ... Williams, A. W. (2013). Risk factors for hospitalization among older, incident haemodialysis patients. Nephrology, 18(11), 712-717. https://doi.org/10.1111/nep.12129

Risk factors for hospitalization among older, incident haemodialysis patients. / Schoonover, Kimberly L.; Hickson, LaTonya; Norby, Suzanne M.; Hogan, Marie C; Chaudhary, Sanjay; Albright, Robert C.; Dillon, John J.; McCarthy, James T.; Williams, Amy W.

In: Nephrology, Vol. 18, No. 11, 2013, p. 712-717.

Research output: Contribution to journalArticle

Schoonover, KL, Hickson, L, Norby, SM, Hogan, MC, Chaudhary, S, Albright, RC, Dillon, JJ, McCarthy, JT & Williams, AW 2013, 'Risk factors for hospitalization among older, incident haemodialysis patients', Nephrology, vol. 18, no. 11, pp. 712-717. https://doi.org/10.1111/nep.12129
Schoonover, Kimberly L. ; Hickson, LaTonya ; Norby, Suzanne M. ; Hogan, Marie C ; Chaudhary, Sanjay ; Albright, Robert C. ; Dillon, John J. ; McCarthy, James T. ; Williams, Amy W. / Risk factors for hospitalization among older, incident haemodialysis patients. In: Nephrology. 2013 ; Vol. 18, No. 11. pp. 712-717.
@article{113d80e34aeb4896adc4188e9efd32cc,
title = "Risk factors for hospitalization among older, incident haemodialysis patients",
abstract = "Aims 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 haemodialysis patients. Methods We reviewed hospitalizations of older (≥65 years) incident chronic haemodialysis patients initiating therapy between 1 January 2007 and 31 December 2009 under the care of a single Midwestern United States dialysis provider. Results 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 totalling 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 (hazard ratios (HR) 2.1, 95{\%} CI 1.4-3.3, P = 0.0005) and the use of a CVC at first haemodialysis (HR 2.6, CI 1.6-4.4, P < 0.0001). Conclusion Hospitalizations are common in older incident haemodialysis 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. Summary at a Glance This study identifies potential factors associated with the frequency and timing of hospitalizations in older patients commencing dialysis, including use of a CVC and initial dialysis when hospitalized. Hospitalizations were mainly because of cardiac and infectious aetiology.",
keywords = "arteriovenous fistula, cardiovascular disease, dialysis access, geriatric nephrology, mortality",
author = "Schoonover, {Kimberly L.} and LaTonya Hickson and Norby, {Suzanne M.} and Hogan, {Marie C} and Sanjay Chaudhary and Albright, {Robert C.} and Dillon, {John J.} and McCarthy, {James T.} and Williams, {Amy W.}",
year = "2013",
doi = "10.1111/nep.12129",
language = "English (US)",
volume = "18",
pages = "712--717",
journal = "Nephrology",
issn = "1320-5358",
publisher = "Wiley-Blackwell",
number = "11",

}

TY - JOUR

T1 - Risk factors for hospitalization among older, incident haemodialysis patients

AU - Schoonover, Kimberly L.

AU - Hickson, LaTonya

AU - Norby, Suzanne M.

AU - Hogan, Marie C

AU - Chaudhary, Sanjay

AU - Albright, Robert C.

AU - Dillon, John J.

AU - McCarthy, James T.

AU - Williams, Amy W.

PY - 2013

Y1 - 2013

N2 - Aims 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 haemodialysis patients. Methods We reviewed hospitalizations of older (≥65 years) incident chronic haemodialysis patients initiating therapy between 1 January 2007 and 31 December 2009 under the care of a single Midwestern United States dialysis provider. Results 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 totalling 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 (hazard ratios (HR) 2.1, 95% CI 1.4-3.3, P = 0.0005) and the use of a CVC at first haemodialysis (HR 2.6, CI 1.6-4.4, P < 0.0001). Conclusion Hospitalizations are common in older incident haemodialysis 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. Summary at a Glance This study identifies potential factors associated with the frequency and timing of hospitalizations in older patients commencing dialysis, including use of a CVC and initial dialysis when hospitalized. Hospitalizations were mainly because of cardiac and infectious aetiology.

AB - Aims 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 haemodialysis patients. Methods We reviewed hospitalizations of older (≥65 years) incident chronic haemodialysis patients initiating therapy between 1 January 2007 and 31 December 2009 under the care of a single Midwestern United States dialysis provider. Results 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 totalling 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 (hazard ratios (HR) 2.1, 95% CI 1.4-3.3, P = 0.0005) and the use of a CVC at first haemodialysis (HR 2.6, CI 1.6-4.4, P < 0.0001). Conclusion Hospitalizations are common in older incident haemodialysis 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. Summary at a Glance This study identifies potential factors associated with the frequency and timing of hospitalizations in older patients commencing dialysis, including use of a CVC and initial dialysis when hospitalized. Hospitalizations were mainly because of cardiac and infectious aetiology.

KW - arteriovenous fistula

KW - cardiovascular disease

KW - dialysis access

KW - geriatric nephrology

KW - mortality

UR - http://www.scopus.com/inward/record.url?scp=84886531456&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84886531456&partnerID=8YFLogxK

U2 - 10.1111/nep.12129

DO - 10.1111/nep.12129

M3 - Article

C2 - 23848358

AN - SCOPUS:84886531456

VL - 18

SP - 712

EP - 717

JO - Nephrology

JF - Nephrology

SN - 1320-5358

IS - 11

ER -