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Kidney Week

Abstract: SA-OR062

Hospitalization Risk Among Younger Adult Hemodialysis Patients: Psychosocial Predictors in the ACTIVE-ADIPOSE Study

Session Information

  • Hemodialysis Potpourri
    November 09, 2019 | Location: 144, Walter E. Washington Convention Center
    Abstract Time: 05:18 PM - 05:30 PM

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism


  • Kutner, Nancy G., Emory University School of Medicine, Atlanta, Georgia, United States
  • Huang, Yijian, Emory University, Atlanta, Georgia, United States

Association of younger age with hospitalization burden and 30-day readmission risk among adult hemodialysis (HD) patients is an unexpected observation in recent national studies, and predictors may be psychosocial in nature (Lin et al. 2019; Chan et al. 2017). Smoking reflects individuals’ priority on health maintenance, and hospitalization risk is known to be elevated among HD patients who smoke, especially younger persons (Li et al. 2018). A dataset that captures granular patient-level data including smoking status and HD treatment adherence facilitates examination of age-stratified risk predictors.


The ACTIVE-ADIPOSE Study (AAS) is a USRDS special study of a multi-center cohort of prevalent HD patients aged 20-92 conducted 2009-2013 at 14 outpatient dialysis clinics in the Atlanta GA and San Francisco areas. Institutional review boards (Emory University, University of California San Francisco) approved the study and all participants provided written informed consent. Study coordinators conducted patient interviews and abstracted patient medical records. In a multivariable regression analysis adjusted for AAS participants’ sociodemographic characteristics and comorbidity, we estimated the association of age, smoking, and HD treatment adherence with all-cause hospitalization burden.


Among 759 AAS participants with data for all variables, younger age was associated with increased odds for hospitalization (p = 0.02). Smoking was associated with 30% increased odds (p = 0.03), and higher frequency of HD sessions skipped was associated with 20% increased odds (p < 0.001), for hospitalization. Compared with non-smokers (n=621), AAS participants who were current smokers (n=138) were younger (52.1 [11.4] vs. 58.2 [14.5]; p <0.001) and more often reported elevated depressive symptoms (36% vs. 22%; p <0.001), and the mean number of HD treatment sessions skipped by smokers compared with non-smokers was twice as high (p = 0.02).


A validated risk score incorporating psychosocial factors may be useful for targeting interventions to reduce HD patients’ risk of hospitalization and 30-day unplanned readmissions (Chan et al. 2017). Younger age, smoking, depression, and treatment non-adherence were prominently associated with hospitalization risk among adult HD patients who participated in the AAS.


  • NIDDK Support