Hospital treatment for fluid overload in the Medicare hemodialysis population.
OBJECTIVE
Fluid overload in hemodialysis patients sometimes requires emergent dialysis, but the magnitude of this care has not been characterized. This study aimed to estimate the magnitude of fluid overload treatment episodes for the Medicare hemodialysis population in hospital settings, including emergency departments.


METHODS
Point-prevalent hemodialysis patients were identified from the Centers for Medicare and Medicaid Renal Management Information System and Standard Analytical Files. Fluid overload treatment episodes were defined by claims for care in inpatient, hospital observation, or emergency department settings with primary discharge diagnoses of fluid overload, heart failure, or pulmonary edema, and dialysis performed on the day of or after admission. Exclusion criteria included stays >5 days. Cost was defined as total Medicare allowable costs for identified episodes. Associations between patient characteristics and episode occurrence and cost were analyzed.


RESULTS
For 25,291 patients (14.3%), 41,699 care episodes occurred over a mean follow-up time of 2 years: 86% inpatient, 9% emergency department, and 5% hospital observation. Heart failure was the primary diagnosis in 83% of episodes, fluid overload in 11%, and pulmonary edema in 6%. Characteristics associated with more frequent events included age <45 years, female sex, African-American race, causes of ESRD other than diabetes, dialysis duration of 1 to 3 years, fewer dialysis sessions per week at baseline, hospitalizations during baseline, and most comorbid conditions. Average cost was $6,372 per episode; total costs were approximately $266 million.


CONCLUSIONS
Among U.S. hemodialysis patients, fluid overload treatment is common and expensive. Further study is necessary to identify prevention opportunities.
Arneson
Thomas J
TJ
Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN 55404, USA. tarneson@cdrg.org
Liu
Jiannong
J
Qiu
Yang
Y
Gilbertson
David T
DT
Foley
Robert N
RN
Collins
Allan J
AJ
D000328:Adult; D000368:Aged; D000465:Algorithms; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000191:economics / Q000209:etiology / Q000628:therapy*; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007297:Inpatients; D007676:Kidney Failure, Chronic / Q000191:economics / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D018803:Models, Economic; D019370:Observation; D011654:Pulmonary Edema / Q000191:economics / Q000209:etiology / Q000628:therapy*; D006435:Renal Dialysis / Q000009:adverse effects* / Q000191:economics; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014883:Water-Electrolyte Imbalance / Q000191:economics / Q000209:etiology / Q000628:therapy*