Outcomes of hemodialysis patients in a long-term care hospital setting: a single-center study.
BACKGROUND
Long-term care hospitals (LTCHs) provide intermediary care after an acute-care hospitalization and usually furnish care to patients with complex medical problems. Outcomes of hemodialysis patients admitted to LTCHs, which includes patients with either end-stage renal disease (ESRD) or acute kidney injury (AKI) requiring dialysis therapy, are not known.


METHODS
Observational study.


METHODS
All consecutive hemodialysis patients admitted to an LTCH.


METHODS
Demographic characteristics, comorbid and laboratory variables, ESRD, and AKI status during LTCH stay.


RESULTS
Disposition from LTCHs was classified as discharge to home, nursing home, death in LTCH or hospice care, and re-admission to the hospital. In patients with AKI, renal recovery was defined as discontinuation of dialysis therapy before meeting disposition outcomes.


RESULTS
96 of 206 (46.6%) patients had ESRD, whereas 110 of 206 (53.3%) developed AKI requiring dialysis therapy during the acute-care hospitalization. 63 of 206 (31%) were discharged to home, 11 of 206 (5.4%) died or transferred to hospice, 81 of 206 (40%) went to a nursing home, and 49 of 206 (24%) were re-admitted to a hospital; mortality after re-admission was 32%. Older age (OR, 0.96; 95% CI, 0.93-0.98), diabetes mellitus (OR, 0.45; 95% CI, 0.23-0.94), number of re-admissions to the hospital (OR, 0.38; 95% CI, 0.18-0.78), aminoglycoside use (OR, 0.16; 95% CI, 0.04-0.64), and duration of hospitalization before LTCH admission (OR, 0.96; 95% CI, 0.94-0.99) were associated with lower odds of discharge to home. Of 110 patients with AKI requiring dialysis therapy, 30% (33 patients) discontinued dialysis therapy, whereas 70% were deemed to have ESRD on discharge.


CONCLUSIONS
Retrospective observational study.


CONCLUSIONS
Most dialysis patients at LTCHs are either re-admitted to acute-care hospitals or require nursing home placement. Only 30% of patients with AKI recover sufficiently to discontinue dialysis therapy, whereas 70% are deemed to have ESRD.
Thakar
Charuhas V
CV
Cincinnati VA Medical Center, Cincinnati, OH, USA. charuhas.thakar@uc.edu
Quate-Operacz
Margaret
M
Leonard
Anthony C
AC
Eckman
Mark H
MH
D058186:Acute Kidney Injury / Q000628:therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D016896:Treatment Outcome