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. 2012 Aug;5(4):315-9.
doi: 10.1093/ckj/sfs071.

Relationship of missed and shortened hemodialysis treatments to hospitalization and mortality: observations from a US dialysis network

Chamberlain I Obialo  1 , William C Hunt  2 , Khalid Bashir  1 , Phillip G Zager  2
Affiliations

Relationship of missed and shortened hemodialysis treatments to hospitalization and mortality: observations from a US dialysis network

Chamberlain I Obialo et al. Clin Kidney J. 2012 Aug.

Abstract

Background: The relationship of missed and shortened hemodialysis (HD) to clinical outcomes has not been well characterized in HD patients in the USA. Here we explored the frequency of missed and shortened treatments and their impact on mortality and hospitalization.

Methods: A retrospective review of data from a cohort of 15 340 HD patients treated in facilities operated by Dialysis Clinics, Inc. We compared the frequency of missed and shortened treatments by gender, race, age and treatment schedules [Mondays, Wednesdays, Fridays (MWF) versus Tuesdays, Thursdays, Saturdays (TTS)].

Results: Of the 15 340 patients, 48% were non-Hispanic whites (NHWs), 41% African Americans (AAs), 6% Hispanics, 2% Native American (NA), 2% Asians and 1% other races. The median number of years on HD was 1.8 years and the median follow-up was 12.4 months. The odds of missing at least one treatment in a month were higher in: patients aged <55 years, odds ratio (OR) 1.33 (P<0.0001); in AAs, OR 1.51 (P < 0.0001); in NAs, OR 1.50 (P = 0.0003); and in Hispanics, OR 1.33 (P = 0.0003) compared with NHWs and in patients who dialyzed on TTS compared with MWF, OR 1.33 (P < 0.0001). Similar findings were observed for treatments shortened by at least 10 min per month. Missed and shortened treatments were most prevalent on Saturdays and were also associated with progressive increases in hospitalization and mortality.

Conclusion: Missed and shortened HD treatments pose a challenge to providers. Improved adherence to prescribed dialysis may decrease the morbidity and mortality.

Keywords: adherence; hospitalization; missed/shortened hemodialysis; mortality.

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Figures

Fig. 1.
Fig. 1.
The percent of missed dialysis treatments by the day of the week; comparisons among all days of the week were significant (P < 0.0001), except Monday versus Friday (P < 0.05). The observations were similar for shortened treatments.
Fig. 2.
Fig. 2.
The relationship between age categories and missed dialysis treatments; ORs and 95% CIs for ≥1 missed treatments during the month using 55–64 years as the reference age category are shown.
Fig. 3.
Fig. 3.
The escalating effects of the number of missed or shortened dialysis treatments in the previous month on age-adjusted mortality rates.
Fig. 4.
Fig. 4.
The escalating effects of the number of missed or shortened dialysis treatments in the previous month on age-adjusted hospitalization rates.
See this image and copyright information in PMC

References

    1. Collins AJ, Foley RN, Gilbertson DT, et al. The state of Chronic Kidney Disease, end stage renal disease and morbidity and mortality in the first year of dialysis. J Am Soc Nephrol. 2009;4:S5–S11. - PubMed
    1. Held PJ, Brunner F, Odaka M, et al. 5 year survival for end stage renal disease patients in the United States, Europe and Japan, 1982–1987. Am J Kidney Dis. 1990;15:451–457. - PubMed
    1. Goodkin DA, Bragg-Gresham JL, Koening KG, et al. Association of comorbid conditions and mortality in hemodialysis patients in Europe, Japan and United States: the Dialysis Outcomes and Practice Patterns Study (DOPPS) J Am Soc Nephrol. 2003;14:3270–3277. - PubMed
    1. Bleyer A, Hylander B, Sudo H, et al. An International study of patient compliance with hemodialysis. J Am Med Assoc. 1999;281:1211–1213. - PubMed
    1. Saran R, Bragg-Gresham JL, Rayner HC, et al. Non-adherence in hemodialysis; associations with mortality, hospitalization, and practice patterns in the DOPPS. Kidney Int. 2003;64:254–262. - PubMed