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Abstract: TH-PO280

The Impact of Debility on Inpatient Mortality and Hospital Costs of ESRD Patients in the United States: A Nationwide Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Nader, Mark Abi, Kidney Care consultants, Memphis, Tennessee, United States
  • Hassan, Oussama, Royal London Hospital, Austin, Texas, United States
  • Aguilar Campos, Rodrigo, Georgetown University Hospital, Washington, District of Columbia, United States
  • Shafique, Rehan, Kidney Care consultants, Memphis, Tennessee, United States
  • Cervantes, Carmen Elena, Aventura Hospital and Medical Center, Aventura, Florida, United States
  • Correa, Ricardo, University of Arizona, Phoenix, Arizona, United States
  • Sharma, Prabin, Yale University Bridgeport Hospital, Bridgeport, Connecticut, United States
  • Vo, Hieu Q., University of Tennessee, Memphis, Tennessee, United States
  • Hamze, Omar, Kidney Care Consultants, Memphis, Tennessee, United States
  • Gordon, Judit, Medstar Georgeotown University Hospital, Washington, District of Columbia, United States
  • Li, Ping, George Washington University, Washington, District of Columbia, United States
Background

Patients on dialysis often suffer from muscle wasting and reduced exercise tolerance compared with the general population. The impact for this debility on the in-patient dialysis population remains unclear. The purpose of the current study was to determine the inpatient mortality and cost effects of debility between dialysis patients.

Methods

Data was extracted from the 2005 to 2012 Nationwide Inpatient Sample (NIS). Using propensity score matching, end stage renal disease (ESRD) patients with debility were matched with ESRD patients without debility at a 1:1 ratio. We compared inpatient mortality, length of stay and total hospital charges between both groups. Analyses were performed using SAS version 9.3 (SAS Institute, Cary, NC, USA).

Results

Among 1,070,450 hospitalized ESRD patients during 2005 to 2012; only 16,810 (1.57%) were identified with debility. These patients were associated with significantly higher rate of gastrointestinal bleed (2.01 vs 1.77%; p=0.02), obesity (11.92 vs 8.37%), acute CHF (39.12 vs 33.94%; p=0.0001), Atrial fibrillation (23.11 vs 15.06%; p=0.0001) and CAD (41.74 vs 33.99; p=0.0001). Surprisingly, ESRD patients with debility had a significantly lower in-hospital mortality compared with ESRD patients without debility before (4.52 vs 5.09%; p=0.001) and after matching (4.53 vs 6.17%, p = 0.0001). Mean length of stay for those with debility was 11.12 days compared with 7.53 days (p < 0.0001). Similarly, mean hospital charges were greater for those who had debility compared with control ($69,596 vs $57,752; p < 0.001).

Conclusion

Debility in dialysis patients appears to have a lower in hospital mortality compared to more conditioned ESRD patients. It does however increase the costs and length of stay. Interventions to lower debility may help reduce hospital expenditures.