title: Hospitalization for initiation of maintenance hemodialysis.
abstract: BACKGROUND
  Recent data on complications of hemodialysis (HD) is lacking. With advancement in dialysis technology the incidence of complications such as dialysis disequilibrium syndrome (DDS) has decreased. Notwithstanding these improvements many patients with end-stage renal disease (ESRD) continue to be hospitalized solely for initiation of hemodialysis. This study was undertaken to assess if such admissions are justified and also to determine incidence and predictors of complications of HD during initiation.
  
  
  METHODS
  Medical records of adult patients (>18 years) initiated on maintenance hemodialysis from January 1st, 1998 through December 31st, 2000 at our institution were reviewed. The demographics of the patients, cause of renal failure, creatinine clearance, type of vascular access, comorbidities, serum chemistries, ultrafiltration (UF) rate and indications for initiating dialysis were noted. Intradialytic complications were retrieved from the dialysis flow sheets.
  
  
  RESULTS
  Of the 240 patients reviewed, 18.3% developed complications during initiation of dialysis, and none was severe. Hypotension and leg cramps were the most frequent complications. The patients who developed hypotension and cramps were significantly older than those with no complications, 57.7 +/- 14.9 (mean +/- SD) years versus 52.3 +/- 14.8 years, respectively (p = 0.02). The increment of age significantly influenced the complication rate [odds ratio (OR): 1.03, 95% confidence interval (CI) 1.01-1.05 (p = 0.03)], and so did hematocrit (HCT) (OR: 1.07, 95% CI 1.01-1.13). Multivariate analysis using age and hematocrit as continuous variables revealed that the older patients with anemia had a significantly higher risk of developing HD related complications than younger patients with anemia (OR: 1.05, 95% CI 1.01-1.09 at HCT of 24%, and OR: 1.03, 95% CI 1.00-1.06 at HCT 27%). When patients were stratified by hematocrit level, older patients with hematocrit <27% had higher risk of complications and the risk increased with increasing age [complication rate (HCT <27%): age <40 = 0%, age 40-64 = 11.7%, age >65 = 25%, p < 0.016].
  
  
  CONCLUSIONS
  Although very few, hypotension and muscle cramps were the main complications during initiation of HD. Older patients with anemia are prone for these complications although no physician intervention was necessary. Hospitalization solely for initiation of maintenance dialysis is not necessary and the additional cost from such admissions cannot be justified.
authors.affiliation: Department of Medicine, Division of Nephrology, University of Texas Medical Branch, Galveston, Tex, USA. mlagraha@utmb.edu
authors.forename: Mahendra
authors.initials: M
authors.lastname: Agraharkar
authors.forename: Mario A
authors.initials: MA
authors.lastname: Martinez
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
authors.forename: Tejinder S
authors.initials: TS
authors.lastname: Ahuja
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005260:Female; D006760:Hospitalization; D006801:Humans; D007022:Hypotension / Q000209:etiology; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009120:Muscle Cramp / Q000209:etiology; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors