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Risk factors for hospital utilization in chronic dialysis patients. Southeastern Kidney Council (Network 6)
M V Rocco1, J M Soucie, D M Reboussin
1Department of Nephrology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC 27157-1053, USA.
Insights
Risk factors for hospitalizations in chronic dialysis patients are similar to mortality risks. Low serum albumin, decreased activity, and diabetes are key predictors, with some modifiable factors like smoking offering intervention potential.
Area of Science:
- Nephrology
- Public Health
- Epidemiology
Background:
- Hospital utilization is a significant concern for patients undergoing chronic dialysis.
- Understanding the risk factors for hospitalizations is crucial for improving patient outcomes.
- The relationship between risk factors for hospital utilization and mortality in dialysis patients requires further investigation.
Purpose of the Study:
- To identify risk factors associated with hospital days per year in chronic dialysis patients.
- To compare these risk factors with those known to increase mortality risk in the same population.
Main Methods:
- A cohort of 1572 patients initiating dialysis in Network 6 (North Carolina, South Carolina, Georgia) in 1989 was analyzed.
- Multiple regression analysis was employed to identify the strongest predictors of annual hospital days.
- Demographic and clinical data, including primary cause of end-stage renal disease (ESRD), comorbidities, and lifestyle factors, were collected.
Main Results:
- Key predictors of increased hospital days included low serum albumin, decreased activity level, diabetes mellitus as the cause of ESRD, peripheral vascular disease, white race, increasing age, absence of hypertension, and presence of angina, smoking, and congestive heart failure.
- The median number of hospital days per year was 8.8.
- The identified risk factors for hospital utilization share similarities with those associated with increased mortality in dialysis patients.
Conclusions:
- The risk factors contributing to hospital utilization in chronic dialysis patients largely overlap with those linked to mortality.
- Modifiable risk factors, such as smoking and decreased activity levels, present opportunities for targeted interventions to reduce hospitalizations.
- Further research into interventional strategies targeting these modifiable factors is warranted to improve the quality of life and reduce healthcare burdens for dialysis patients.
Abstract:
It is not known if the risk factors for hospital utilization are similar to the risk factors for mortality in chronic dialysis patients. The risk factors associated with hospital days per year of patient risk were identified in a subset of patients in Network 6 (the states of North Carolina, South Carolina, and Georgia) who began dialysis in 1989. The demographic characteristics of this cohort of 1572 patients included a mean (+/- SD) age of 57.4 +/- 15.0 yr; 63.7% of the patients were African American, 52.4% were female, and 33.0% had diabetes mellitus as the primary cause of ESRD. The median number of hospital days per year of patient risk was 8.8, with 25th and 75th quartiles of 3.9 and 20.1, respectively. By using multiple regression analysis, the strongest predictors of the number of hospital days per year of patient risk included low serum albumin level (P = 0.0001), decreased activity level (P = 0.0006), diabetes mellitus as the primary cause of ESRD (P = 0.002), peripheral vascular disease (P = 0.004), white race (P = 0.01), increasing age (P = 0.03), the absence of hypertension (P = 0.03), and the presence of angina (P = 0.03), smoking (P = 0.03), and congestive heart failure (P = 0.045). These risk factors are similar to those reported for an increased risk of mortality in dialysis patients and some of them, such as smoking, are modifiable and may be amenable to interventional strategies.