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Inpatient hemodialysis initiation: reasons, risk factors and outcomes

Deidra C Crews1, Bernard G Jaar, Laura C Plantinga

  • 1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. dcrews1@jhmi.edu

Nephron. Clinical Practice
|October 10, 2009
PubMed

Insights

Starting chronic hemodialysis as an inpatient may reduce hospitalizations, especially for patients with late nephrology referral, comorbidities, or low social support. This contrasts with the general view of inpatient initiation being undesirable.

Area of Science:

  • Nephrology
  • Public Health
  • Healthcare Management

Background:

  • Inpatient initiation of chronic hemodialysis is often avoided due to high costs and hospitalization risks.
  • Understanding patient characteristics and outcomes associated with inpatient initiation is crucial for optimizing care pathways.

Purpose of the Study:

  • To investigate patient demographics and clinical outcomes linked to initiating chronic hemodialysis during an inpatient stay.
  • To assess the association between inpatient hemodialysis initiation and subsequent patient health events.

Main Methods:

  • A prospective cohort study design was employed.
  • Multivariable analyses were used to evaluate the independent association of inpatient initiation with outcomes, adjusting for patient factors and propensity scores.

Main Results:

  • 63% of incident hemodialysis patients (410/652) initiated as inpatients, primarily due to uremia and volume overload.
  • Inpatient initiators were more likely to be unmarried, have less social support, multiple comorbidities, and late nephrology referral.
  • Inpatient initiation showed a protective association against all-cause hospitalization (IRR=0.92) and infectious hospitalizations, particularly in high-risk groups.

Conclusions:

  • Inpatient hemodialysis initiation demonstrates a protective effect on subsequent hospitalizations for specific patient subgroups.
  • Patients referred late to nephrology, those with multiple comorbidities, or limited social support may benefit from inpatient initiation regarding hospitalization risk.
Abstract

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