title: Hospitalization in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients.
abstract: BACKGROUND
  Cardiovascular disease is a common cause of hospitalization in dialysis patients. Daily hemodialysis improves some parameters of cardiovascular function, but whether it associates with lower hospitalization risk is unclear.
  
  
  METHODS
  Observational cohort study using US Renal Data System data.
  
  
  METHODS
  Medicare-enrolled daily (5 or 6 sessions weekly) home hemodialysis (HHD) patients initiating NxStage System One use from January 1, 2006, through December 31, 2009, and contemporary thrice-weekly in-center hemodialysis patients, matched 5 to 1.
  
  
  METHODS
  Daily HHD or thrice-weekly in-center hemodialysis.
  
  
  METHODS
  All-cause and cause-specific hospital admissions, hospital readmissions, and hospital days assessed from Medicare Part A claims.
  
  
  RESULTS
  For 3,480 daily HHD and 17,400 thrice-weekly in-center hemodialysis patients in intention-to-treat analysis, the HR of all-cause admission for daily HHD versus in-center hemodialysis was 1.01 (95%CI, 0.98-1.03). Cause-specific admission HRs were 0.89 (95%CI, 0.86-0.93) for cardiovascular disease, 1.18 (95%CI, 1.13-1.23) for infection, 1.01 (95%CI, 0.93-1.09) for vascular access dysfunction, and 1.02 (95%CI, 0.99-1.06) for other morbidity. Regarding cardiovascular disease, first admission and readmission HRs for daily HHD versus in-center hemodialysis were 0.91 and 0.87, respectively. Regarding infection, first admission and readmission HRs were 1.35 and 1.03, respectively. Protective associations of daily HHD with heart failure and hypertensive disease were most pronounced, as were adverse associations of daily HHD with bacteremia/sepsis, cardiac infection, osteomyelitis, and vascular access infection.
  
  
  CONCLUSIONS
  Results may be confounded by unmeasured factors, including vascular access type; information about dialysis frequency, duration, and dose was lacking; causes of admission may be misclassified; results may not apply to patients without Medicare coverage.
  
  
  CONCLUSIONS
  All-cause hospitalization risk was similar in daily HHD and thrice-weekly in-center hemodialysis patients. However, risk of cardiovascular-related admission was lower with daily HHD, and risk of infection-related admission was higher. More attention should be afforded to infection in HHD patients.
authors.affiliation: Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN. Electronic address: eweinhandl@cdrg.org.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Weinhandl
authors.affiliation: Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Nieman
authors.affiliation: Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: David T
authors.initials: DT
authors.lastname: Gilbertson
authors.affiliation: Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN; Department of Medicine, University of Minnesota, Minneapolis, MN.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Collins
mesh_terms: D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006437:Hemodialysis, Home / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007239:Infections / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008483:Medical Assistance / Q000706:statistics & numerical data; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: Hemodialysis; cardiovascular disease; daily HHD; end-stage renal disease (ESRD); home hemodialysis (HHD); hospital admission; hospitalization; infection