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Bakkaloğlu SA, Özdemir Atikel Y, Schmitt CP, Lévai E, Adalat S, Goodman N, Dursun İ, Pınarbaşı AS, Yazıcıoğlu B, Paglialonga F, Vondrak K, Guzzo I, Printza N, Zurowska A, Zagożdżon I, Karabay Bayazıt A, Atmış B, Tkaczyk M, Faria MDS, Zaloszyc A, Jankauskienė A, Ekim M, Edefonti A, Shroff R. Comparative analysis of hospitalizations among patients treated with hemodialysis and peritoneal dialysis in European pediatric nephrology centers: results from a prospective EPDWG/ESPN Dialysis Working Group study. Clin Kidney J 2024; 17:sfad291. [PMID: 38223336 PMCID: PMC10784969 DOI: 10.1093/ckj/sfad291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Indexed: 01/16/2024] Open
Abstract
Background and hypothesis Hospital admissions in pediatric dialysis patients need to be better studied, and most existing studies are retrospective and based on registry data. This study aimed to analyse and compare hospital admission rates, causes, length of stay (LOS), and outcomes in children treated with peritoneal dialysis (PD) and hemodialysis (HD). Methods Data from 236 maintenance PD and 138 HD patients across 16 European dialysis centers were collected between 1 July 2017 and 30 June 2018. A total of 178 hospitalized patients (103 PD, 75 HD) were included for further analyses. Results There were 465 hospitalization events (268 PD, 197 HD) with a rate of 0.39 admissions per 100 patient-days at risk (PDAR) and 2.4 hospital days per 100 PDAR. The admission rates were not significantly different between HD and PD patients. The most common causes of hospitalization were access-related infections (ARI) (17%), non-infectious complications of access (NIAC) (14%), and infections unrelated to access (12%). ARI was the leading cause in PD patients (24%), while NIAC was more common in HD patients (19%). PD patients had more ARIs, diagnostic procedures, and treatment adjustments (P < .05), while HD patients had more NIACs, infections unrelated to access, access placement procedures, and interventional/surgical procedures (P < .001). LOS was longer with acute admissions than non-acute admissions (P < .001). Overall LOS and LOS in the intensive care unit were similar between HD and PD patients. High serum uric acid and low albumin levels were significant predictors of longer LOS (P = .022 and P = .045, respectively). Young age, more significant height deficit, and older age at the start of dialysis were predictors of longer cumulative hospital days (P = .002, P = .001, and P = .031, respectively). Conclusion Access-related complications are the main drivers of hospitalization in pediatric dialysis patients, and growth and nutrition parameters are significant predictors of more extended hospital stays.
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Affiliation(s)
- Sevcan A Bakkaloğlu
- Department of Pediatric Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Yeşim Özdemir Atikel
- Department of Pediatric Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
- Department of Pediatric Nephrology, Eskişehir City Hospital, Eskişehir, Turkey
| | - Claus Peter Schmitt
- Department of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, Heidelberg, Germany
| | - Eszter Lévai
- Department of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, Heidelberg, Germany
| | - Shazia Adalat
- Department of Pediatric Nephrology, Evelina London Children's Hospital, London, United Kingdom
| | - Nadine Goodman
- Department of Pediatric Nephrology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - İsmail Dursun
- Department of Pediatric Nephrology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Ayşe Seda Pınarbaşı
- Department of Pediatric Nephrology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Burcu Yazıcıoğlu
- Department of Pediatric Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Fabio Paglialonga
- Department of Pediatric Nephrology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Karel Vondrak
- Department of Pediatric Nephrology, University Hospital Motol, Prague, Czech Republic
| | - Isabella Guzzo
- UO di Nefrologia e Dialisi, Ospedale Pediatrico Bambino Gesu-IRCCS, Rome, Italy
| | - Nikoleta Printza
- Department of Pediatric Nephrology, Medical School of Aristotle University, Thessaloniki, Greece
| | - Aleksandra Zurowska
- Department of Pediatrics Nephrology & Hypertension, Medical University of Gdansk, Gdansk, Poland
| | - Ilona Zagożdżon
- Department of Pediatrics Nephrology & Hypertension, Medical University of Gdansk, Gdansk, Poland
| | - Aysun Karabay Bayazıt
- Department of Pediatric Nephrology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Bahriye Atmış
- Department of Pediatric Nephrology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Marcin Tkaczyk
- Department of Pediatric Nephrology, Instytut Centrum Zdrowia, Matki, Poland
| | - Maria do Sameiro Faria
- Department of Pediatric Nephrology, Centro Materno-Infantil do Norte, CHP, Porto, Portugal
| | - Ariane Zaloszyc
- Department of Pediatric Nephrology, Country Hautepierre CHU, Strasbourg, France
| | - Augustina Jankauskienė
- Institute of Clinical Medicine, Vilnius University, Pediatric Center, Vilnius, Lithuania
| | - Mesiha Ekim
- Department of Pediatric Nephrology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Alberto Edefonti
- Department of Pediatric Nephrology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rukshana Shroff
- Department of Pediatric Nephrology, Great Ormond Street Hospital for Children, London, United Kingdom
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Vienken J, Port FK. "Theoria cum Praxi": Science between Curiosity and Benefit - A Tribute to Jürgen Bommer (1942-2022). Blood Purif 2022; 51:717-720. [PMID: 35468596 DOI: 10.1159/000524581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hickson LJ, Thorsteinsdottir B, Ramar P, Reinalda MS, Crowson CS, Williams AW, Albright RC, Onuigbo MA, Rule AD, Shah ND. Hospital Readmission among New Dialysis Patients Associated with Young Age and Poor Functional Status. Nephron Clin Pract 2018; 139:1-12. [PMID: 29402792 DOI: 10.1159/000485985] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/01/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Over one-third of hospital discharges among dialysis patients are followed by 30-day readmission. The first year after dialysis start is a high-risk time frame. We examined the rate, causes, timing, and predictors of 30-day readmissions among adult, incident dialysis patients. METHODS Hospital readmissions were assessed from the 91st day to the 15th month after the initiation of dialysis using a Mayo Clinic registry linkage to United States Renal Data System claims during the period January 2001-December 2010. RESULTS Among 1,727 patients with ≥1 hospitalization, 532 (31%) had ≥1, and 261 (15%) had ≥2 readmissions. Readmission rate was 1.1% per person-day post-discharge, and the highest rates (2.5% per person-day) occurred ≤5 days after index admission. The overall cumulative readmission rate was 33.8% at day 30. Common readmission diagnoses included cardiac issues (22%), vascular disorders (19%), and infection (13%). Similar-cause readmissions to index hospitalization were more common during days 0-14 post-discharge than days 15-30 (37.5 vs. 22.9%; p = 0.004). Younger age at dialysis initiation, inability to transfer/ambulate, serum creatinine ≤5.3 mg/dL, higher number of previous hospitalizations, and longer duration on dialysis were associated with higher readmission rates in multivariable analyses. Patients aged 18-39 were few (8.3%) but comprised 17.7% of "high-readmission" users such that a 30-year-old patient had an 87% chance of being readmitted within 30 days of any hospital discharge, whereas an 80-year-old patient had a 25% chance. CONCLUSIONS Overall, 30-day readmissions are common within the first year of dialysis start. The first 10-day period after discharge, young patients, and those with poor functional status represent key areas for targeted interventions to reduce readmissions.
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Affiliation(s)
- LaTonya J Hickson
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bjorg Thorsteinsdottir
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Priya Ramar
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Megan S Reinalda
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Cynthia S Crowson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy W Williams
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert C Albright
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Macaulay A Onuigbo
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nilay D Shah
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
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Chan L, Chauhan K, Poojary P, Saha A, Hammer E, Vassalotti JA, Jubelt L, Ferket B, Coca SG, Nadkarni GN. National Estimates of 30-Day Unplanned Readmissions of Patients on Maintenance Hemodialysis. Clin J Am Soc Nephrol 2017; 12:1652-1662. [PMID: 28971982 PMCID: PMC5628712 DOI: 10.2215/cjn.02600317] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/26/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients on hemodialysis have high 30-day unplanned readmission rates. Using a national all-payer administrative database, we describe the epidemiology of 30-day unplanned readmissions in patients on hemodialysis, determine concordance of reasons for initial admission and readmission, and identify predictors for readmission. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This is a retrospective cohort study using the Nationwide Readmission Database from the year 2013 to identify index admissions and readmission in patients with ESRD on hemodialysis. The Clinical Classification Software was used to categorize admission diagnosis into mutually exclusive clinically meaningful categories and determine concordance of reasons for admission on index hospitalizations and readmissions. Survey logistic regression was used to identify predictors of at least one readmission. RESULTS During 2013, there were 87,302 (22%) index admissions with at least one 30-day unplanned readmission. Although patient and hospital characteristics were statistically different between those with and without readmissions, there were small absolute differences. The highest readmission rate was for acute myocardial infarction (25%), whereas the lowest readmission rate was for hypertension (20%). The primary reasons for initial hospitalization and subsequent 30-day readmission were discordant in 80% of admissions. Comorbidities that were associated with readmissions included depression (odds ratio, 1.10; 95% confidence interval [95% CI], 1.05 to 1.15; P<0.001), drug abuse (odds ratio, 1.41; 95% CI, 1.31 to 1.51; P<0.001), and discharge against medical advice (odds ratio, 1.57; 95% CI, 1.45 to 1.70; P<0.001). A group of high utilizers, which constituted 2% of the population, was responsible for 20% of all readmissions. CONCLUSIONS In patients with ESRD on hemodialysis, nearly one quarter of admissions were followed by a 30-day unplanned readmission. Most readmissions were for primary diagnoses that were different from initial hospitalization. A small proportion of patients accounted for a disproportionate number of readmissions.
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Affiliation(s)
- Lili Chan
- Division of Nephrology, Department of Medicine
| | | | | | | | - Elizabeth Hammer
- Division of Nephrology, Department of Medicine, New York University Lutheran Hospital, New York, New York; and
| | - Joseph A. Vassalotti
- Division of Nephrology, Department of Medicine
- National Kidney Foundation, Inc., New York, New York
| | | | - Bart Ferket
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
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Canaud B, Chénine L, Leray-Moraguès H, Patrier L, Rodriguez A, Gontier-Picard A, Moréna M. [Online hemodiafiltration: Practical aspects, safety and efficacy]. Nephrol Ther 2017; 13:189-201. [PMID: 28483384 DOI: 10.1016/j.nephro.2017.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Purification of high molecular uremic toxins by conventional hemodialysis is limited. It remains associated with a high morbidity and excessively high mortality. Online hemodiafiltration using a high permeability hemodiafilter, an ultrapure dialysate, and which tends to maximize substitution volumes, provides a high efficiency and low bio-incompatibility renal supplementation. Regular use of online hemodiafiltration is associated with reduced morbidity (reduction of intradialytic hypotension episodes, improved blood pressure control, reduced inflammatory profile, better anemia correction and prevention of β2-microglobulin-associated amyloidosis). Recently, several cohort studies have shown that hemodiafiltration with high substitution volume was associated with a significant reduction in mortality. Randomized studies have been conducted in Europe to confirm these facts. The high safety of online hemodiafiltration has been confirmed in clinical practice by prospective studies. Online hemodiafiltration has reached its full maturity phase and is expected to represent the new standard of renal replacement therapy.
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Affiliation(s)
- Bernard Canaud
- Néphrologie, dialyse et soins intensifs, hôpital Lapeyronie, CHRU de Montpellier, 375, avenue du Doyen-Giraud, 34925 Montpellier cedex 5, France; Association pour l'installation à domicile des épurations rénales (Aider), 746, rue de la Croix-de-Lavit, 34192 Montpellier, France; Institut de recherche et formation en dialyse (IRFD), hôpital Lapeyronie, CHRU de Montpellier, 375, avenue du Doyen-Giraud, 34295 Montpellier, France.
| | - Leïla Chénine
- Néphrologie, dialyse et soins intensifs, hôpital Lapeyronie, CHRU de Montpellier, 375, avenue du Doyen-Giraud, 34925 Montpellier cedex 5, France; Institut de recherche et formation en dialyse (IRFD), hôpital Lapeyronie, CHRU de Montpellier, 375, avenue du Doyen-Giraud, 34295 Montpellier, France
| | - Hélène Leray-Moraguès
- Néphrologie, dialyse et soins intensifs, hôpital Lapeyronie, CHRU de Montpellier, 375, avenue du Doyen-Giraud, 34925 Montpellier cedex 5, France; Association pour l'installation à domicile des épurations rénales (Aider), 746, rue de la Croix-de-Lavit, 34192 Montpellier, France; Institut de recherche et formation en dialyse (IRFD), hôpital Lapeyronie, CHRU de Montpellier, 375, avenue du Doyen-Giraud, 34295 Montpellier, France
| | - Laure Patrier
- Néphrologie, dialyse et soins intensifs, hôpital Lapeyronie, CHRU de Montpellier, 375, avenue du Doyen-Giraud, 34925 Montpellier cedex 5, France
| | - Annie Rodriguez
- Institut de recherche et formation en dialyse (IRFD), hôpital Lapeyronie, CHRU de Montpellier, 375, avenue du Doyen-Giraud, 34295 Montpellier, France
| | - A Gontier-Picard
- Néphrologie, dialyse et soins intensifs, hôpital Lapeyronie, CHRU de Montpellier, 375, avenue du Doyen-Giraud, 34925 Montpellier cedex 5, France; Institut de recherche et formation en dialyse (IRFD), hôpital Lapeyronie, CHRU de Montpellier, 375, avenue du Doyen-Giraud, 34295 Montpellier, France
| | - Marion Moréna
- Institut de recherche et formation en dialyse (IRFD), hôpital Lapeyronie, CHRU de Montpellier, 375, avenue du Doyen-Giraud, 34295 Montpellier, France
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Besstremyannaya G. Differential Effects of Declining Rates in a Per Diem Payment System. HEALTH ECONOMICS 2016; 25:1599-1618. [PMID: 25470236 DOI: 10.1002/hec.3128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/18/2014] [Accepted: 10/27/2014] [Indexed: 06/04/2023]
Abstract
The paper demonstrates differential effects of a prospective payment system with declining per diem rates, dependent on the percentiles of length of stay. The analysis uses dynamic panel data estimates and a recent nationwide administrative database for major diagnostic categories in 1068 Japanese hospitals in 2006-2012 to show that average length of stay significantly increases for hospitals in percentiles 0-25 of the pre-reform length of stay and significantly decreases for hospitals in percentiles 51-100. The decline of the average length of stay is larger for hospitals in higher percentiles of the length of stay. Hospitals in percentiles 51-100 significantly increase their rate of nonemergency/unanticipated readmissions within 42 days after discharge. The decline in the length of total episode of treatment is smaller for hospitals in percentiles 0-25. The findings are robust in terms of the choice of a cohort of hospitals joining the reform. The paper discusses applicability of 'best practice' rate-setting to help improve the performance of hospitals in the lowest quartile of average length of stay. Copyright © 2015 John Wiley & Sons, Ltd.
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Flythe JE, Katsanos SL, Hu Y, Kshirsagar AV, Falk RJ, Moore CR. Predictors of 30-Day Hospital Readmission among Maintenance Hemodialysis Patients: A Hospital's Perspective. Clin J Am Soc Nephrol 2016; 11:1005-1014. [PMID: 27151893 PMCID: PMC4891757 DOI: 10.2215/cjn.11611115] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/23/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Over 35% of patients on maintenance dialysis are readmitted to the hospital within 30 days of hospital discharge. Outpatient dialysis facilities often assume responsibility for readmission prevention. Hospital care and discharge practices may increase readmission risk. We undertook this study to elucidate risk factors identifiable from hospital-derived data for 30-day readmission among patients on hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data were taken from patients on maintenance hemodialysis discharged from University of North Carolina Hospitals between May of 2008 and June of 2013 who received in-patient hemodialysis during their index hospitalizations. Multivariable logistic regression models with 30-day readmission as the dependent outcome were used to identify readmission risk factors. Models considered variables available at hospital admission and discharge separately. RESULTS Among 349 patients, 112 (32.1%) had a 30-day hospital readmission. The discharge (versus admission) model was more predictive of 30-day readmission. In the discharge model, malignancy comorbid condition (odds ratio [OR], 2.08; 95% confidence interval [95% CI], 1.04 to 3.11), three or more hospitalizations in the prior year (OR, 1.97; 95% CI, 1.06 to 3.64), ≥10 outpatient medications at hospital admission (OR, 1.69; 95% CI, 1.00 to 2.88), catheter vascular access (OR, 1.82; 95% CI, 1.01 to 3.65), outpatient dialysis at a nonuniversity-affiliated dialysis facility (OR, 3.59; 95% CI, 2.03 to 6.36), intradialytic hypotension (OR, 3.10; 95% CI, 1.45 to 6.61), weekend discharge day (OR, 1.82; 95% CI, 1.01 to 3.31), and serum albumin <3.3 g/dl (OR, 4.28; 95% CI, 2.37 to 7.73) were associated with higher readmission odds. A decrease in prescribed medications from admission to discharge (OR, 0.20; 95% CI, 0.08 to 0.51) was associated with lower readmission odds. Findings were robust across different model-building approaches. CONCLUSIONS Models containing discharge day data had greater predictive capacity of 30-day readmission than admission models. Identified modifiable readmission risk factors suggest that improved medication education and improved transitions from hospital to community may potentially reduce readmissions. Studies evaluating targeted transition programs among patients on dialysis are needed.
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Affiliation(s)
- Jennifer E. Flythe
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine and
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
| | - Suzanne L. Katsanos
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine and
| | - Yichun Hu
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine and
| | - Abhijit V. Kshirsagar
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine and
| | - Ronald J. Falk
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine and
| | - Carlton R. Moore
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; and
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
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Tentori F, McCullough K, Kilpatrick RD, Bradbury BD, Robinson BM, Kerr PG, Pisoni RL. High rates of death and hospitalization follow bone fracture among hemodialysis patients. Kidney Int 2014; 85:166-73. [PMID: 23903367 PMCID: PMC3910091 DOI: 10.1038/ki.2013.279] [Citation(s) in RCA: 231] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 05/16/2013] [Accepted: 05/23/2013] [Indexed: 11/22/2022]
Abstract
Altered bone structure and function contribute to the high rates of fractures in dialysis patients compared to the general population. Fracture events may increase the risk of subsequent adverse clinical outcomes. Here we assessed the incidence of post-fracture morbidity and mortality in an international cohort of 34,579 in-center hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). We estimated country-specific rates of fractures requiring a hospital admission and associated length of stay in the hospital. Incidence rates of death and of a composite event of death/rehospitalization were estimated for 1 year after fracture. Overall, 3% of participants experienced a fracture. Fracture incidence varied across countries, from 12 events/1000 patient-years (PY) in Japan to 45/1000 PY in Belgium. In all countries, fracture rates were higher in the hemodialysis group compared to those reported for the general population. Median length of stay ranged from 7 to 37 days in the United States and Japan, respectively. In most countries, postfracture mortality rates exceeded 500/1000 PY and death/rehospitalization rates exceeded 1500/1000 PY. Fracture patients had higher unadjusted rates of death (3.7-fold) and death/rehospitalization (4.0-fold) compared to the overall DOPPS population. Mortality and hospitalization rates were highest in the first month after the fracture and declined thereafter. Thus, the high frequency of fractures and increased adverse outcomes following a fracture pose a significant health burden for dialysis patients. Fracture prevention strategies should be identified and applied broadly in nephrology practices.
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Affiliation(s)
- Francesca Tentori
- Arbor Research Collaborative for Health, Ann Arbor MI
- Vanderbilt University Medical Center, Nashville TN
| | | | | | - Brian D. Bradbury
- Center for Observational Research, Amgen, Inc., Thousand Oaks CA
- Department of Epidemiology, University of California, Los Angeles, Los Angeles CA
| | - Bruce M. Robinson
- Arbor Research Collaborative for Health, Ann Arbor MI
- University of Michigan, Ann Arbor MI
| | - Peter G. Kerr
- Monash Medical Centre and Monash University, Clayton Australia
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Toyabe SI, Cao P, Abe T, Uchiyama M, Akazawa K. Impact of sociocultural factors on hospital length of stay in children with nephrotic syndrome in Japan. Health Policy 2005; 76:259-65. [PMID: 16026888 DOI: 10.1016/j.healthpol.2005.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2005] [Accepted: 06/11/2005] [Indexed: 10/25/2022]
Abstract
Hospital length of stay (LOS) of Japanese inpatients is extraordinarily long, partly because of the nature of the health insurance system in Japan. We investigated factors that affect the LOS in Japan, taking pediatric nephrosis as an example. The characteristics of 78 hospitalized children with steroid-sensitive nephrotic syndrome were studied. The median LOS of the patients was 47 days. Most of the patients' mothers (92.3%) stayed in hospital during admission to care for their children. Using multivariate Cox's regression analysis with time-dependent covariates, non-working mother and smaller number of siblings were found to be factors significantly associated with prolonged LOS. These factors are presumed to allow the mothers to care for their hospitalized children for a long period. No medical or clinical factors played a significant role in the prolonged LOS. These results suggest that sociocultural factors have a greater influence on the LOS in Japan than do medical factors such as disease course, coexisting illness, complications, and treatment response.
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Affiliation(s)
- Shin-Ichi Toyabe
- Department of Medical Informatics, Niigata University Medical and Dental Hospital, Asahimachi-dori 1-754, Niigata 951-8520, Japan.
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Tadaki F, Inagaki M, Miyamoto Y, Tanaka SI, Tanaka R, Kakuta T, Saito A. Early hospital readmission was less likely for hemodialysis patients from facilities with longer median length of stay in the DOPPS study. Hemodial Int 2005; 9:23-9. [PMID: 16191050 DOI: 10.1111/j.1492-7535.2005.01114.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The length of hospital stay is considered to influence hospital readmission in general. The Dialysis Outcomes and Practice Patterns Study (DOPPS), an international prospective observational study undertaken to establish a relationship between facility practices and dialysis outcomes, started in 1996. Results suggest that the duration of hospital stay is significantly correlated with the probability of early readmission in dialysis patients. Thus, early hospital readmission was observed to be less likely for hemodialysis patients from facilities with longer median length of stay. The lengths of hospital stay for hemodialysis patients differed in the three continents studied. Although socioeconomic pressures may drive the lengths of hospital stay, the duration of hospitalization should be determined keeping in mind the safety of clinical course for each disease. In this forum, a 47-year-old female hemodialysis patient with severe secondary hyperparathyroidism, who had been treated with hemodialysis for 21 years, was hospitalized with severe clinical symptoms. Although the clinical symptoms disappeared 10 days after total parathyroidectomy with autotransplantation, severe hypocalcemia persisted despite large amounts of intravenous calcium gluconate. This patient was hospitalized for a long duration owing to the large calcium deficit in her body. Had the length of her hospital stay been shortened, either she could have needed rehospitalization or her condition could have worsened.
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Affiliation(s)
- Futoshi Tadaki
- Division of Nephrology, Department of Medicine, Institute of Medical Science, Tokai University, Bohseidai, Isehara, Kanagawa 259-1193, Japan.
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