Abstract: TH-PO902

First and Recurrent Hospitalized Infections in Home and In-Center Hemodialysis Patients

Session Information

  • Dialysis: Infection
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 610 Dialysis: Infection

Authors

  • Weinhandl, Eric D., NxStage Medical, Inc., Victoria, Minnesota, United States
  • Collins, Allan J., NxStage Medical, Inc., Victoria, Minnesota, United States
Background

Compared to thrice-weekly in-center hemodialysis (IHD), daily home hemodialysis (HHD) is associated with higher risk of infection-related hospitalization (IH). Strategies to reduce risk of infectious complications on HHD are needed to improve clinical and economic outcomes. We aimed to estimate the incidence of first and recurrent IHs in HHD and IHD patients with a fistula.

Methods

We analyzed data from the United States Renal Data System. The HHD cohort comprised patients who completed HHD training with the NxStage System One in 2006-2012 and who carried Medicare as primary payer (MPP). The IHD cohort comprised patients who initiated IHD in 2006-2012 and who carried MPP. We followed patients until the earliest of modality change, death, or December 31, 2012. We ascertained IHs from principal discharge diagnoses on Medicare claims. We estimated the cumulative incidence of IH, stratified by the cumulative number of prior IHs on HHD or IHD, and the hazard ratio of IH for HHD versus IHD, with adjustment for age, race, sex, ESRD duration, and primary cause of ESRD.

Results

We identified 4304 HHD and 46,988 IHD patients. On both HHD and IHD, the cumulative incidence of IH increased with each additional IH discharge (figure). For HHD versus IHD, the adjusted hazard ratio (AHR) of first IH was 1.24 (95% confidence interval, 1.07-1.44); the AHR of second IH, following discharge from the first IH, was 1.01 (0.86-1.19); and the AHR of each subsequent IH, following discharge from the preceding IH, was 0.92 (0.78-1.09).

Conclusion

Compared to IHD patients with a fistula, HHD patients with a fistula had higher risk of a first IH, but similar or slightly lower risk of recurrent IHs. However, in both dialytic settings, each additional IH discharge increased the risk of another IH. Less time to first IH in HHD patients prematurely sets in motion the cycle of increasing risk, ultimately manifesting as a higher IH rate on HHD versus IHD. Attention should be devoted to prevention of the first infection on HHD.