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Infection, CVD cause of higher hospitalization rate prior to patients on home hemodialysis returning to in-center care
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DALLAS — Patients on home hemodialysis have higher hospitalization rates just before transferring back to in-center hemodialysis care, but many of the causes for admission are preventable, according to a study presented at the Annual Dialysis Conference.
“Hospitalization is increasingly likely during the last 3 months preceding conversion from [home hemodialysis] HHD to [in-center hemodialysis] IHD, ” wrote Eric Weinhandl, PhD, a clinical epidemiologist and biostatistician at NxStage Medical, and colleagues. “The rate of admission during the last month preceding conversion is roughly three-times higher than is typical on HHD.”
However, many of those admissions “may be preventable with better volume management and infection control,” they wrote. Thirty-one percent were due to infections, including vascular access infection, sepsis and pneumonia, while 24% were due to cardiovascular disease.
The researchers analyzed Medicare claims and NxStage Medical prescription records from 1,521 patients who converted from HHD back to IHD.
“During the third-to-last, second-to-last, and last months preceding conversion from HHD to IHD, the percentages of patients [at a minimum of] 1 hospital admission increased steadily; 36% of patients were hospitalized during [at least] 2 of the 3 months. During the last month preceding conversion, the rate of hospital admissions was equivalent to 4.5 events per patient-year,” they wrote.
All patients in the study group started HHD with NxStage’s System One machine between Jan. 1, 2006 and Dec. 31, 2012 and had to be dialyzing at least 3 months prior to the start of the study.
“Hospitalization rates are quite elevated compared to the norms” for patients on HHD prior to converting back to IHD, Weinhandl told Healio/Nephrology. Once the patient is discharged, “it’s a good idea to do some good post-discharge coordination with the patient” to determine the cause of the hospitalization and how the patient is feeling about HHD. “There is a likely risk that they may want to drop out at this point,” if the cause is fluid- or infection-related, he said. Likewise, those clinical issues, not necessarily patient or care partner burnout, may be the problem for patients on HHD. “This data could indicate that patient/care partner burnout may be overstated” and the problems are more clinical-related. –by Mark E. Neumann
Reference:
Weinhandl E, et al. Presented at the Annual Dialysis Conference; March 16-19, 2018; Dallas.
Disclosure: Weinhandl reports no relevant financial disclosures.