title: Outcomes of infection-related hospitalization in Medicare beneficiaries receiving in-center hemodialysis.
abstract: BACKGROUND
  Infection is a common cause of hospitalization in adults receiving hemodialysis. Limited data are available about downstream events resulting from or following these hospitalizations.
  
  
  METHODS
  Retrospective cohort study using the US Renal Data System.
  
  
  METHODS
  Medicare beneficiaries initiating in-center hemodialysis therapy in 2005 to 2008.
  
  
  METHODS
  Demographics, dual Medicare/Medicaid eligibility, body mass index, comorbid conditions, initial vascular access type, nephrology care prior to dialysis therapy initiation, residence in a care facility, tobacco use, biochemical measures, and type of infection.
  
  
  RESULTS
  30-day hospital readmission or death following first infection-related hospitalization.
  
  
  RESULTS
  60,270 Medicare beneficiaries had at least one hospitalization for infection. Of those who survived the initial hospitalization, 15,113 (27%) were readmitted and survived the 30 days following hospital discharge, 1,624 (3%) were readmitted to the hospital and then died within 30 days of discharge, and 2,425 (4%) died without hospital readmission. Complications related to dialysis access, sepsis, and heart failure accounted for 12%, 9%, and 7% of hospital readmissions, respectively. Factors associated with higher odds of 30-day readmission or death without readmission included non-Hispanic ethnicity, lower serum albumin level, inability to ambulate or transfer, limited nephrology care prior to dialysis therapy, and specific types of infection. In comparison, older age, select comorbid conditions, and institutionalization had stronger associations with death without readmission than with readmission.
  
  
  CONCLUSIONS
  Findings limited to Medicare beneficiaries receiving in-center hemodialysis.
  
  
  CONCLUSIONS
  Hospitalizations for infection among patients receiving in-center hemodialysis are associated with exceptionally high rates of 30-day hospital readmission and death without readmission.
authors: Department of Medicine, University of California Davis, Davis, CA. Electronic address: lorien.dalrymple@ucdmc.ucdavis.edu.
authors: Lorien S
authors: LS
authors: Dalrymple
authors: Department of Public Health Sciences, University of California Davis, Davis, CA.
authors: Yi
authors: Y
authors: Mu
authors: Department of Medicine, University of California Davis, Davis, CA.
authors: Patrick S
authors: PS
authors: Romano
authors: Department of Medicine, University of California Irvine, Irvine, CA.
authors: Danh V
authors: DV
authors: Nguyen
authors: Department of Medicine, Stanford University School of Medicine, Palo Alto, CA.
authors: Glenn M
authors: GM
authors: Chertow
authors: San Francisco VA Medical Center, University of California San Francisco, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA.
authors: Cynthia
authors: C
authors: Delgado
authors: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
authors: Barbara
authors: B
authors: Grimes
authors: Department of Medicine, University of California Davis, Davis, CA.
authors: George A
authors: GA
authors: Kaysen
authors: San Francisco VA Medical Center, University of California San Francisco, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
authors: Kirsten L
authors: KL
authors: Johansen
mesh_terms: D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D006435:Renal Dialysis; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000628:therapy; D018805:Sepsis / Q000453:epidemiology / Q000628:therapy
keywords: Infection; Medicare beneficiaries; dialysis access; discharge diagnosis; end-stage renal disease (ESRD); hemodialysis; hospital readmission; infection-related hospitalization; mortality; sepsis; survival; transitions of care
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