Hospitalization in Daily Home Hemodialysis and Matched Thrice-Weekly In-Center Hemodialysis Patients
| Autor: | Eric D. Weinhandl, David T. Gilbertson, Allan J. Collins, Kimberly Nieman |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Hemodialysis Home Disease Infections Ambulatory Care Facilities Risk Assessment Cohort Studies Sepsis Risk Factors Outcome Assessment Health Care medicine Humans Registries Intensive care medicine Dialysis Medical Assistance business.industry Home hemodialysis Middle Aged medicine.disease United States Hospitalization Cardiovascular Diseases Nephrology Heart failure Bacteremia Emergency medicine Kidney Failure Chronic Female Hemodialysis business Cohort study |
| Zdroj: | American Journal of Kidney Diseases. 65:98-108 |
| ISSN: | 0272-6386 |
| Popis: | Background Cardiovascular disease is a common cause of hospitalization in dialysis patients. Daily hemodialysis improves some parameters of cardiovascular function, but whether it associates with lower hospitalization risk is unclear. Study Design Observational cohort study using US Renal Data System data. Setting & Participants Medicare-enrolled daily (5 or 6 sessions weekly) home hemodialysis (HHD) patients initiating NxStage System One use from January 1, 2006, through December 31, 2009, and contemporary thrice-weekly in-center hemodialysis patients, matched 5 to 1. Predictor Daily HHD or thrice-weekly in-center hemodialysis. Outcomes & Measurements All-cause and cause-specific hospital admissions, hospital readmissions, and hospital days assessed from Medicare Part A claims. Results For 3,480 daily HHD and 17,400 thrice-weekly in-center hemodialysis patients in intention-to-treat analysis, the HR of all-cause admission for daily HHD versus in-center hemodialysis was 1.01 (95%CI, 0.98-1.03). Cause-specific admission HRs were 0.89 (95%CI, 0.86-0.93) for cardiovascular disease, 1.18 (95%CI, 1.13-1.23) for infection, 1.01 (95%CI, 0.93-1.09) for vascular access dysfunction, and 1.02 (95%CI, 0.99-1.06) for other morbidity. Regarding cardiovascular disease, first admission and readmission HRs for daily HHD versus in-center hemodialysis were 0.91 and 0.87, respectively. Regarding infection, first admission and readmission HRs were 1.35 and 1.03, respectively. Protective associations of daily HHD with heart failure and hypertensive disease were most pronounced, as were adverse associations of daily HHD with bacteremia/sepsis, cardiac infection, osteomyelitis, and vascular access infection. Limitations Results may be confounded by unmeasured factors, including vascular access type; information about dialysis frequency, duration, and dose was lacking; causes of admission may be misclassified; results may not apply to patients without Medicare coverage. Conclusions All-cause hospitalization risk was similar in daily HHD and thrice-weekly in-center hemodialysis patients. However, risk of cardiovascular-related admission was lower with daily HHD, and risk of infection-related admission was higher. More attention should be afforded to infection in HHD patients. |
| Databáze: | OpenAIRE |
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