Risk factors for unexpected clinical deterioration in hospitalized patients undergoing maintenance hemodialysis

Unplanned intensive care unit (ICU) transfers owing to clinical deterioration contribute to in-hospital mortality. The risk factors for unplanned ICU transfers among the general population have been investigated, whereas those among patients undergoing hemodialysis remain unclear. Therefore, this study aimed to examine the risk factors for clinical deterioration in hospitalized patients undergoing hemodialysis.

We conducted a single-center, retrospective, observational cohort study, focusing on hospitalized adult patients receiving maintenance hemodialysis between January 2003 and December 2020. Age, sex, planned or emergency hospitalization type, hemodialysis duration, vital signs, quick sequential organ failure assessment score, serum albumin levels, and comorbid conditions (diabetes mellitus, coronary artery disease [CAD], peripheral artery disease, cerebrovascular disease, intradialytic hypotension, and cancer) were considered as predictors. For all predictors, data at admission were used. Outcomes measured included clinical deterioration, unplanned ICU transfers within 72 h to 30 days after admission, and sudden death within 30 days.

Among the 389 enrolled patients (median age: 73.1 years, 64.3% male), 40 patients experienced clinical deterioration: 37 (9.5%) underwent unplanned ICU transfers, and 3 (0.8%) experienced sudden deaths in general wards. In-hospital mortality was significantly higher in the deterioration group than in the non-deterioration group (62.5% vs 5.4%, p < 0.001, respectively). Cox regression analysis identified CAD as an independent risk factor for clinical deterioration (hazard ratio: 2.11; 95% confidence interval: 1.05-4.24).

CAD is a risk factor for clinical deterioration in hospitalized patients undergoing hemodialysis.