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Multicenter Study
. 2010;114(1):c19-28.
doi: 10.1159/000245066. Epub 2009 Oct 9.

Inpatient hemodialysis initiation: reasons, risk factors and outcomes

Deidra C Crews  1 , Bernard G Jaar, Laura C Plantinga, Hania S Kassem, Nancy E Fink, Neil R Powe
Affiliations
Multicenter Study

Inpatient hemodialysis initiation: reasons, risk factors and outcomes

Deidra C Crews et al. Nephron Clin Pract. 2010.

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.

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Figures

Fig. 1
Fig. 1
Documented reasons for inpatient dialysis initiation (n = 410). Reasons for the remaining 11.0% (45 of 410) were various combinations of those noted in this figure. 1 Uremia includes symptoms such as nausea/vomiting, fatigue, anorexia, metallic taste and pruritus. 2 Other documented reasons included: progressive renal failure, status-post cardiac catheterization, and status-post cardiac surgery. 3 HTN = Hypertension.
See this image and copyright information in PMC

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