Abstract: FR-PO898

In-Patient Hospitalization of Dialysis Patients in Canada: Opportunities to Decrease the Burden on Patients

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Wu, Juliana, Canadian Institute for Health Information, Toronto, Ontario, Canada
  • Terner, Michael, Canadian Institute for Health Information, Toronto, Ontario, Canada
  • Lam, Kelvin, Canadian Institute for Health Information, Toronto, Ontario, Canada
  • Ivis, Frank, Canadian Institute for Health Information, Toronto, Ontario, Canada
  • Webster, Greg, Canadian Institute for Health Information, Toronto, Ontario, Canada
  • Klarenbach, Scott, University of Alberta, Edmonton, Alberta, Canada
Background

All cause hospitalization rates for dialysis patients is high, with 1.7 hospitalizations per patient-year reported in the United States. In Canada, the Canadian Organ Replacement Register program at the Canadian Institute for Health Information examined hospitalization in Canada for both all-cause, and infections related to dialysis treatment.

Methods

A cohort of 38,369 incident dialysis patients between 2005 and 2014 were included in the study. Crude rates for hospitalization (all cause and infection) and in-hospital mortality were calculated. A frailty model was used to calculate hazard ratios for covariates including age, sex, race, income, comorbidity, primary diagnosis, year of dialysis start, care type, modality and pre-dialysis hospitalization.

Results

The all-cause hospitalization rate for dialysis patients was 1.1 hospitalizations per patient-year. Pediatric patients (HR = 2.73; p<0.001) and Indigenous patients (HR = 1.20; p<0.001) had higher risk than peers for hospitalization, and patients on home hemodialysis and peritoneal dialysis (HR = 0.84; p<0.001) had a lower risk of being hospitalized than in-centre patients. Similar results were observed for hospitalization for infections related to dialysis. All-cause hospitalizations were more frequent at dialysis initiation and decreased over time for both patients receiving peritoneal or hemodialysis.

Conclusion

Targeted national interventions such as promoting greater arteriovenous fistula use to reduce catheter infections, earlier transplantation for pediatric patients and expanding programs designed to improve care to Indigenous patients could be used to reduce the rate of hospitalization for higher-risk dialysis patients in Canada.