title: Risk factors for hospitalization among older, incident haemodialysis patients.
abstract: OBJECTIVE
  The number of elderly persons with end-stage renal disease is increasing with many requiring hospitalizations. This study examines the causes and predictors of hospitalization in older haemodialysis patients.
  
  
  METHODS
  We reviewed hospitalizations of older (≥65 years) incident chronic haemodialysis patients initiating therapy between 1 January 2007 and 31 December 2009 under the care of a single Midwestern United States dialysis provider.
  
  
  RESULTS
  Of 125 patients, the mean age was 76 ± 7 years and 72% were male. At first dialysis, 68% used a central venous catheter (CVC) and 51% were in the hospital. Mean follow-up was 1.8 ± 1.0 years. At least one hospitalization occurred in 89 (71%) patients and half of all patients were hospitalized once within the first 223 days. Total hospital admission rate was 1.48 per patient year with hospital days totalling 8.54 days per patient year. The three most common reasons for first admission were cardiac (33%), infection (18%) and gastrointestinal (12%). Predictors of future hospitalization included the first dialysis occurring in hospital (hazard ratios (HR) 2.1, 95% CI 1.4-3.3, P = 0.0005) and the use of a CVC at first haemodialysis (HR 2.6, CI 1.6-4.4, P < 0.0001).
  
  
  CONCLUSIONS
  Hospitalizations are common in older incident haemodialysis patients. Access preparation and overall burden of illness leading to the initial hospitalization appear to play a role. Identification of additional factors associated with hospitalization will allow for focused interventions to reduce hospitalization rates and increase the value of care.
authors.affiliation: Department of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Kimberly L
authors.initials: KL
authors.lastname: Schoonover
authors.forename: Latonya J
authors.initials: LJ
authors.lastname: Hickson
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Norby
authors.forename: Marie C
authors.initials: MC
authors.lastname: Hogan
authors.forename: Sanjay
authors.initials: S
authors.lastname: Chaudhary
authors.forename: Robert C
authors.initials: RC
authors.lastname: Albright
authors.forename: John J
authors.initials: JJ
authors.lastname: Dillon
authors.forename: James T
authors.initials: JT
authors.lastname: McCarthy
authors.forename: Amy W
authors.initials: AW
authors.lastname: Williams
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: arteriovenous fistula; cardiovascular disease; dialysis access; geriatric nephrology; mortality