Inpatient hemodialysis initiation: reasons, risk factors and outcomes.
OBJECTIVE
Inpatient initiation of chronic hemodialysis is considered undesirable because of cost and possible harms of hospitalization. We examined the patient characteristics and outcomes associated with inpatient initiation.


METHODS
In a prospective cohort study of incident dialysis patients, the independent association of inpatient hemodialysis initiation with patient outcomes was assessed in multivariable analyses with adjustment for patient characteristics and propensity for inpatient initiation.


RESULTS
A total of 410 of 652 (63%) hemodialysis patients began as inpatients; uremia and volume overload were the most commonly documented reasons. Compared to outpatients, inpatients were more likely to be unmarried, report less social support, have multiple comorbidities and be referred to a nephrologist 4 months or less prior to initiation. Inpatient initiation was protective for subsequent all-cause hospitalization (incidence rate ratio (IRR) = 0.92, confidence interval (CI) 0.89-0.94); this was most pronounced among those who had the highest propensity for inpatient initiation (IRR = 0.66, CI 0.56-0.78), including those referred late to nephrology. Similar results were found for infectious hospitalization. Mortality [hazard ratio = 1.03, CI 0.82-1.30] and cardiovascular events were not significantly different for inpatients versus outpatients.


CONCLUSIONS
Inpatient hemodialysis initiation has a protective association with hospitalization among those patients referred late to nephrology, with multiple comorbidities and/or little social support.
Crews
Deidra C
DC
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. dcrews1@jhmi.edu
Jaar
Bernard G
BG
Plantinga
Laura C
LC
Kassem
Hania S
HS
Fink
Nancy E
NE
Powe
Neil R
NR
D000328:Adult; D000368:Aged; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012307:Risk Factors; D016896:Treatment Outcome