title: Risk Factors for Infection-Related Hospitalization in In-Center Hemodialysis.
abstract: OBJECTIVE
  Infection-related hospitalizations have increased dramatically over the last 10 years in patients receiving in-center hemodialysis. Patient and dialysis facility characteristics associated with the rate of infection-related hospitalization were examined, with consideration of the region of care, rural-urban residence, and socioeconomic status.
  
  
  METHODS
  The US Renal Data System linked to the American Community Survey and Rural-Urban Commuting Area codes was used to examine factors associated with hospitalization for infection among Medicare beneficiaries starting in-center hemodialysis between 2005 and 2008. A Poisson mixed effects model was used to examine the associations among patient and dialysis facility characteristics and the rate of infection-related hospitalization.
  
  
  RESULTS
  Among 135,545 Medicare beneficiaries, 38,475 (28%) had at least one infection-related hospitalization. The overall rate of infection-related hospitalization was 40.2 per 100 person-years. Age ≥ 85 years old, cancer, chronic obstructive pulmonary disease, inability to ambulate or transfer, drug dependence, residence in a care facility, serum albumin <3.5 g/dl at dialysis initiation, and dialysis initiation with an access other than a fistula were associated with a ≥ 20% increase in the rate of infection-related hospitalization. Patients residing in isolated small rural compared with urban areas had lower rates of hospitalization for infection (rate ratio, 0.91; 95% confidence interval, 0.86 to 0.97), and rates of hospitalization for infection varied across the ESRD networks. Measures of socioeconomic status (at the zip code level), total facility staffing, and the composition of staff (percentage of nurses) were not associated with the rate of hospitalization for infection.
  
  
  CONCLUSIONS
  Patient and facility factors associated with higher rates of infection-related hospitalization were identified. The findings from this study can be used to identify patients at higher risk for infection and inform the design of infection prevention strategies.
authors.affiliation: Departments of Medicine and ldalrymple@ucdavis.edu.
authors.forename: Lorien S
authors.initials: LS
authors.lastname: Dalrymple
authors.affiliation: Health Sciences, University of California, Davis, California;
authors.forename: Yi
authors.initials: Y
authors.lastname: Mu
authors.affiliation: Department of Medicine, University of California, Irvine, California;
authors.forename: Danh V
authors.initials: DV
authors.lastname: Nguyen
authors.affiliation: Departments of Medicine and.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Romano
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Palo Alto, California;
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.affiliation: Departments of Epidemiology and Biostatistics and.
authors.forename: Barbara
authors.initials: B
authors.lastname: Grimes
authors.affiliation: Departments of Medicine and.
authors.forename: George A
authors.initials: GA
authors.lastname: Kaysen
authors.affiliation: Departments of Epidemiology and Biostatistics and Nephrology Section San Francisco Department of Veterans Affairs Medical Center, San Francisco, California Medicine, University of California, San Francisco, California; and.
authors.forename: Kirsten L
authors.initials: KL
authors.lastname: Johansen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D015897:Comorbidity; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D006278:Medicare; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012111:Residence Characteristics; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D019035:Rural Health Services; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D019037:Urban Health Services; D055815:Young Adult
keywords: end-stage renal disease; epidemiology and outcomes; hemodialysis; hospitalization; humans; kidney failure, chronic; renal dialysis; risk factors; serum albumin; social class