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Hospitalization during advancing chronic kidney disease.
T-Christian H Mix1, Wendy L St peter, Jim Ebben
1Tufts-New England Medical Center, Boston, MA, USA.
Summary
Hospitalizations increase as end-stage renal disease (ESRD) approaches, particularly after starting dialysis. Managing cardiovascular disease and vascular access during chronic kidney disease (CKD) may reduce these events.
Area of Science:
- Nephrology
- Public Health
- Healthcare Management
Background:
- End-stage renal disease (ESRD) care incurs significant societal costs, largely due to high hospitalization rates.
- The impact of declining kidney function on hospitalization risk as ESRD nears is not fully understood.
Purpose of the Study:
- To evaluate hospitalization frequency in patients with chronic kidney disease (CKD) approaching ESRD.
- To analyze hospitalization trends and causes in the period before and after dialysis initiation.
Main Methods:
- Retrospective cohort study using national Medicare data.
- Included patients with CKD who reached ESRD and had at least two years of Medicare eligibility prior to dialysis.
- Study period: two years before to six months after dialysis initiation.
Main Results:
- Cohort: 109,321 patients, mean age 75, initiating dialysis 1995-1998.
- Mean hospitalization rate: 134/1,000 patient-months at risk (PMAR).
- Rates peaked post-dialysis initiation (487/1,000 PMAR), driven by vascular access, cardiovascular disease (CVD), and infections.
Conclusions:
- Hospitalizations escalate as ESRD approaches and continue post-dialysis.
- CKD-related comorbidities are the primary cause of these hospitalizations.
- Improved prevention/management of CVD and timely vascular access placement during CKD could reduce hospitalizations.