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. 2021 Oct;25(4):548-559.
doi: 10.1111/hdi.12943. Epub 2021 Jun 16.

Epidemiology of nursing home dialysis patients-A hidden population

Eran Y Bellin  1 , Alice M Hellebrand  2 , Steven M Kaplan  2 , Jordan G Ledvina  2 , William T Markis  3 , Nathan W Levin  4 , Allen M Kaufman  2
Affiliations

Epidemiology of nursing home dialysis patients-A hidden population

Eran Y Bellin et al. Hemodial Int. 2021 Oct.

Abstract

Introduction: Dialysis patients are often discharged from hospitals to skilled nursing facilities (SNFs), but little has been published about their natural history.

Methods: Using electronic medical record data, we conducted a retrospective cohort study of nursing home patients treated with in-SNF hemodialysis from January 1, 2018 through June 20, 2020 within a dialysis organization across eight states. A dialytic episode began with the first in-SNF dialysis and was ended by hospitalization, death, transfer, or cessation of treatment. The clinical characteristics and natural history of these patients and their dialytic episodes are described.

Findings: Four thousand five hundred and ten patients experienced 9274 dialytic episodes. Dialytic episodes had a median duration of 18 days (IQR: 8-38) and were terminated by a hospitalization n = 5747 (62%), transfer n = 2638 (28%), death n = 568 (6%), dialysis withdrawal n = 129 (1.4%), recovered function n = 2 (0.02%), or other cause n = 6 (0.06%). Increased patient mortality was associated with advancing age, low serum creatinine, albumin, or sodium, and low pre-dialytic systolic blood pressure (sBP). U-shaped relationships to mortality were observed for intradialytic hypotension frequency and for post- > pre-hemodialysis sBP frequency. Prescription of dialysis five times weekly in the first 2 weeks was associated with better survival in the first 90 days (HR 0.77, CI 0.62-0.96; p < 0.02).

Discussion: Provision of in-SNF dialysis by an external dialysis organization enables discharge from the acute care setting for appropriate treatment with increased nursing contact time in an otherwise under-resourced environment. SNF ESRD patient clinical characteristics and outcomes are extensively characterized for the first time.

Keywords: ESRD; epidemiology; hemodialysis; intradialytic hypotension; mortality risk factors; nursing home.

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Conflict of interest statement

Allen M. Kaufman, Alice M. Hellebrand, and Jordan G. Ledvina are current employees of Dialyze Direct and hold stock and/or stock options in Dialyze Direct. Steven M. Kaplan is a current employee of Dialyze Direct. Nathan W. Levin is a consultant for Dialyze Direct and chair of its Medical Advisory Board. Eran Y. Bellin is a consultant epidemiologist for Dialyze Direct, and William T. Markis is a consultant research analyst and medical writer for Dialyze Direct.

Figures

FIGURE 1
FIGURE 1
Cumulative mortality (one minus Kaplan–Meier) plots by age bracket, stratified by percent of dialyses with intradialytic hypotension within a dialytic episode. (a) 10%–25% of dialysis sessions with intradialytic hypotension and (b) 75%–100% of dialysis sessions with intradialytic hypotension. Intradialytic hypotension was defined by experiencing nadir systolic blood pressure < 90 mmHg (or <100 mmHg if pre‐hemodialysis systolic blood pressure was >150 mmHg) [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

References

    1. USRDS Renal data extraction and referencing (RenDER) system. Available from: https://render.usrds.org/render/xrender.phtml.
    1. United States Renal Data System . 2019. USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD. Reference Table C.4(2), Available from: https://www.usrds.org/annual-data-report/. .
    1. Bowling CB, Zhang R, Franch H, Huang Y, Mirk A, McClellan WM, et al. Underreporting of nursing home utilization on the CMS‐2728 in older incident dialysis patients and implications for assessing mortality risk. BMC Nephrol. 2015;16:32. - PMC - PubMed
    1. Kurella Tamura M, Montez‐Rath ME, Hall YN, Katz R, O'Hare AM. Advance directives and end‐of‐life care among nursing home residents receiving maintenance dialysis. Clin J Am Soc Nephrol. 2017;12:435–42. - PMC - PubMed
    1. Bowling CB, Plantinga L, Hall RK, Mirk A, Zhang R, Kutner N. Association of nondisease‐specific problems with mortality, long‐term care, and functional impairment among older adults who require skilled nursing care after dialysis initiation. Clin J Am Soc Nephrol. 2016;11:2218–24. - PMC - PubMed