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Abstract: FR-PO785

Cumulative Time in Hospital After Initiation of Dialysis: A Cohort Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Tennankore, Karthik K., Dalhousie University/NS Health Authority, Halifax, Nova Scotia, Canada
  • Clark, David, London Health Sciences Centre, London, Ontario, Canada
  • Matheson, Kara, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
  • Vinson, Amanda Jean, Dalhousie University/NS Health Authority, Halifax, Nova Scotia, Canada
Background

Chronic dialysis patients are at risk for frequent and prolonged hospitalizations. Less is known about predictors of cumulative time in hospital after initiation of dialysis, including each subsequent hospitalization. Having an awareness of the predictors of cumulative hospital time is important for informed decision making between patients and providers prior to initiation of dialysis.

Methods

We analyzed a cohort of incident, chronic dialysis patients from 2009-2014 (last follow-up of 2015) at a tertiary care center. Baseline characteristics including demographics, comorbidities, frailty status (assessed using the clinical frailty scale; CFS rated from 1: very fit to 7: severely frail) and laboratory parameters were captured in all patients at dialysis initiation. The primary outcome was cumulative time in hospital (proportion of time in hospital/total follow-up time and inclusive of the time in hospital after dialysis initiation for inpatient dialysis starts). Generalized linear models were used to fit a negative binomial distribution of cumulative time with total time of followup as the offset.

Results

A total of 647 patients were included in the study. Mean age was 62 ± 15 years, 90% were caucasian and the majority (63%) were male. Diabetes (48%), coronary artery disease (30%), congestive heart failure (22%), and cancer (11%) were prevalent at dialysis initiation; a smaller proportion (5%) had underlying liver disease. The median CFS score was 4 (IQR 2.5) corresponding to "vulnerable but not frail". Median days in hospital for the cohort was 13 (IQR 41) and cumulative hospital time was 3% of total follow-up time (48/1704 years). In an adjusted model, the percent change in the incident rate of cumulative days in hospital was 22% for each 1 point increase in frailty severity. Other factors associated with higher cumulative time included age (IRR 1.02, 95% CI 1.01-1.03 per year), liver disease (IRR 2.07, 95% CI 1.07-4.02), malignancy prior to dialysis initiation (IRR 1.78, 95% CI 1.09-2.90) and low albumin (IRR 0.93, 95% CI 0.91-0.96 per each g/L decrease in albumin).

Conclusion

Demographics, comorbidities, frailty status and laboratory parameters are associated with a higher cumulative time in hospital after dialysis initiation. This information may be used to better inform patients of their risk of hospitalization after starting chronic dialysis.