Abstract
Infection is a common cause of hospitalization in adults receiving hemodialysis. Limited data are available about downstream events resulting from or following these hospitalizations. Retrospective cohort study using the US Renal Data System. Medicare beneficiaries initiating in-center hemodialysis therapy in 2005 to 2008. 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. 30-day hospital readmission or death following first infection-related hospitalization. 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. Findings limited to Medicare beneficiaries receiving in-center hemodialysis. Hospitalizations for infection among patients receiving in-center hemodialysis are associated with exceptionally high rates of 30-day hospital readmission and death without readmission.
Highlights
MethodsStudy Cohort and Data CollectionWe assembled data from the US Renal Data System (USRDS) on Medicare part A and B beneficiaries who initiated dialysis from January 1, 2005 through June 30, 2008, survived the first 90 days of dialysis, and were receiving in-center hemodialysis at a free-standing dialysis facility with known profit status on day 91.6 We retrieved baseline data on age; sex; race; ethnicity; co-morbidities including diabetes, heart failure, hypertension, chronic obstructive pulmonary disease (COPD), coronary artery disease, peripheral vascular disease, cerebrovascular disease (cerebrovascular accident or transient ischemic attack (CVA/TIA), cancer and amputation; tobacco use; vascular access type; and Quételet’s (body mass) index (BMI) at dialysis initiation, nephrology care and biochemical studies (serum creatinine, albumin and hemoglobin concentrations) prior to dialysis initiation, and residence in a care facility (nursing home, assisted living or other) at dialysis initiation (Centers for Medicare & Medicaid Services [CMS] Form 2728)
Infection is a common cause of hospitalization in adults receiving hemodialysis
Hospitalizations for infection among patients receiving in-center hemodialysis are associated with exceptionally high rates of 30-day hospital readmission and death without readmission
Summary
Study Cohort and Data CollectionWe assembled data from the US Renal Data System (USRDS) on Medicare part A and B beneficiaries who initiated dialysis from January 1, 2005 through June 30, 2008, survived the first 90 days of dialysis, and were receiving in-center hemodialysis at a free-standing dialysis facility with known profit status on day 91.6 We retrieved baseline data on age; sex; race; ethnicity; co-morbidities including diabetes, heart failure, hypertension, chronic obstructive pulmonary disease (COPD), coronary artery disease, peripheral vascular disease, cerebrovascular disease (cerebrovascular accident or transient ischemic attack (CVA/TIA), cancer and amputation; tobacco use; vascular access type; and Quételet’s (body mass) index (BMI) at dialysis initiation, nephrology care and biochemical studies (serum creatinine, albumin and hemoglobin concentrations) prior to dialysis initiation, and residence in a care facility (nursing home, assisted living or other) at dialysis initiation (Centers for Medicare & Medicaid Services [CMS] Form 2728). We included hospitalizations for which the date of admission was the same as the date of discharge and we combined hospitalizations with overlapping dates of admission and discharge into a single hospitalization, with discharge diagnoses selected from the hospital record with the earliest start date or longest length of stay (8% of all hospitalizations in our cohort). This approach minimizes the likelihood of counting admissions/transfers directly to inpatient rehabilitation facilities or other acute inpatient facilities as hospital readmissions, as the latter hospitalizations would have been combined into a single hospitalization record
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