The mortality and hospitalization rates associated with the long interdialytic gap in thrice-weekly hemodialysis patients

Abstract Background and Aims Coagulation disorders with both risk for bleeding and thrombotic events are common in hemodialysis (HD) patients. Altered thrombocyte counts and function may account for that. Here, we sought to better characterize thrombocyte function in hemodialysis patients. Method Platelet function was investigated using the Multiplate analyzer (Roche) based on impedance aggregometry. Adenosine diphosphate (ADP) was used to induce platelet aggregation and area under the curve (AUC) was used as primary endpoint. Platelet counts and C-reactive protein (CRP) levels were measured. Hospitalization was the primary clinical outcome. Pearson regression was used to test for associations of thrombocyte function and the primary endpoint. Results In total 60 chronic HD patients undergoing dialysis 3 times per week, and 67 healthy controls were included. In general, HD patients presented with significantly lower thrombocyte numbers compared to healthy controls (Median: 221 vs. 245 G/l, p=0.029). Further, thrombocyte function as determined by AUC was significantly altered in HD patients versus healthy controls (Median: 455 vs. 677 AU*min, p<0.001; figure 1) with a significant correlation for platelet count and platelet function (r=0.42, p=0.001). Platelet function also correlated with the inflammatory state as seen by systemic CRP levels (r=0.28, p=0.033). Regarding the clinical outcome, platelet function correlated with hospitalization rates for infectious disease (r=0.27; p=0.040) and cardiovascular events (r=0.30; p=0.022). In case of hospitalization rates for infectious disease this correlation remained stable irrespective of adjustment for thrombocyte counts (r=0.27, p=0.036). Conclusion Lower platelet counts and altered function in HD patients was associated with risk of hospitalization and markers of inflammation in this cohort. The Multiplate analyzer appeared to be a valid and easily accessible method to assess thrombocyte function. Further studies are needed to determine whether assessment of thrombocyte function in clinical routine should be used to stratify risk in the vulnerable population of HD patients.

Download Full-text

Impact of Nutrition Supplements on Hospitalization Rates in Incident Hemodialysis Patients

Journal of Renal Nutrition ◽

10.1053/j.jrn.2019.03.070 ◽

2019 ◽

Vol 29 (3) ◽

pp. 262

Keyword(s):

Hemodialysis Patients ◽

Hospitalization Rates

Download Full-text

Management of Hemodialysis Patients with Suspected or Confirmed COVID-19 Infection: Perspective from the Spanish Nephrology

Kidney360 ◽

10.34067/kid.0002602020 ◽

2020 ◽

Vol 1 (11) ◽

pp. 1254-1258

Author(s):

Emilio Sánchez-Alvarez ◽

Manuel Macía ◽

Patricia de Sequera Ortiz

Keyword(s):

Signs And Symptoms ◽

Hemodialysis Patients ◽

Comorbid Conditions ◽

Spanish Society ◽

Risk Of Death ◽

Hospitalization Rates ◽

Dialysis Vintage ◽

The Mean ◽

Clinical Conditions ◽

Overall Mortality

BackgroundThe recent SARS-CoV-2 coronavirus pandemic has signified a significant effect on the health of the population worldwide. Patients on chronic RRT have been affected by the virus, and they are at higher risk due to the frequent comorbid conditions. Here, we show the results of the COVID-19 Registry of the Spanish Society of Nephrology during the first 6 weeks of the outbreak.MethodsThis study is an analysis of the data recorded on a registry of patients with ESKD on RRT who tested positive for COVID-19. The aim was to evaluate clinical conditions, therapeutic management, and consequences, including outcome. The registry began on March 18th, 2020. It includes epidemiologic data, cause of CKD, signs and symptoms of the infection, treatments, and outcomes. Patients were diagnosed with SARS-CoV-2 infection on the basis of the results of PCR of the virus obtained from nasopharyngeal/oropharyngeal swabs. The tests were performed on symptomatic patients and on those who mentioned contact with infected patients.ResultsAs of May 2, the registry included data on 1397 patients (in-center hemodialysis [IC-HD], 63%; kidney transplant [Tx], 34%; peritoneal dialysis [PD], 3%; and home hemodialysis, 0.3%). The mean age was 67±15 years, and two-thirds were men. Dialysis vintage was 46±41 months, and the time after transplantation was 59±54 months. Eighty-five percent of the patients required hospital admission, and 8% had to be transferred to intensive care units. Overall mortality was 25% (IC-HD, 27%; Tx, 23%; and PD, 15%), and significant proportions of deceased patients have advanced age, are on IC-HD, and presented pneumonia. Age and pneumonia were independently associated with the risk of death.ConclusionsSARS-CoV-2 infection affected a significant number of Spanish patients on RRT, mainly those on IC-HD. Hospitalization rates and mortality were high. The factors more closely related to mortality were age and pneumonia.

Download Full-text

The Impact of Comorbidity Burden on The Association between Vascular Access Type and Clinical Outcomes among Elderly Patients Undergoing Hemodialysis

Scientific Reports ◽

10.1038/s41598-019-54191-1 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Jong Hyun Jhee ◽

Seun Deuk Hwang ◽

Joon Ho Song ◽

Seoung Woo Lee

Keyword(s):

Vascular Access ◽

Survival Rates ◽

Hemodialysis Patients ◽

Korean Society ◽

Hospitalization Rates ◽

Risk Of Mortality ◽

Increased Risk ◽

Comorbidity Burden ◽

The Impact ◽

Elderly Hemodialysis Patients

AbstractThe optimal vascular access type for elderly hemodialysis patients is controversial. We evaluated the impact of comorbidity burden on the association between vascular access type and mortality risk among 23,100 hemodialysis patients aged ≥65 years from the Korean Society of Nephrology End-Stage Renal Disease registry data. Subjects were stratified into tertiles according to the simplified Charlson comorbidity index (sCCI), and the survival and hospitalization rates were compared with respect to vascular access type: arteriovenous fistula (AVF), arteriovenous graft (AVG), and central venous catheter (CVC). Among all tertiles of sCCI, CVC use showed highest risk of mortality than AVF use. In the lowest to middle tertile, no difference was observed in survival rates between the use of AVF and AVG. However, in the highest tertile, AVG use showed higher risk of mortality than AVF use. When subjects were classified according to a combination of sCCI tertile and access type (AVF vs. AVG), patients with the highest CCI with AVG showed 1.75-folded increased risk of mortality than those with the lowest sCCI with AVF. Hospitalization rates due to access malfunction were highest in patients with CVC in all sCCI tertiles. In the highest tertile, patients with AVG showed increased rates of hospitalization compared to those with AVF due to access malfunction. However, hospitalization rates due to access infection were highest in patients with AVG in all tertiles. The use of AVF may be of benefit and switching to AVF should be considered in elderly hemodialysis patients with a high burden of comorbidity.

Download Full-text

A Simple and Cheap Hospitalization Risk Assessment Tool for Use in Hemodialysis Patients

Blood Purification ◽

10.1159/000490544 ◽

2018 ◽

Vol 46 (4) ◽

pp. 265-268

Author(s):

Muhammad Nauman Hashmi ◽

Hammad Raza ◽

Wael Elshazly ◽

Fayez Hejaili ◽

Abdullah Al Sayyari

Keyword(s):

Diabetes Mellitus ◽

High Risk ◽

Vascular Access ◽

Assessment Tool ◽

Risk Group ◽

Hemodialysis Patients ◽

High Risk Group ◽

Low Risk ◽

Group Score ◽

Hospitalization Rates

Objective: To develop a simple, objective, cheap scoring tool incorporating nutritional parameters and other variables to predict hospitalization and mortality among hemodialysis patients – a tool that could be utilized in low resource countries. Methods: The following variables were scored according to severity into 0, 1, 2 or 3: BMI, functional capacity, HD vintage in years, serum albumin, serum ferritin, and the number of comorbid conditions (diabetes mellitus, hypertension, ischemic heart disease, cerebrovascular disease). This tool was evaluated on our regular hemodialysis patients who were followed up for 24 months (June 2015 till July 2017). In our study population, the maximum score recorded was 12; accordingly, a score of 6 was used to differentiate between a low-risk group (score < 6) or a high-risk group (score ≥6). The 2 groups were compared (using the Chi square test) for possible differences in mortality and hospitalization rates during the follow-up period. Results: One hundred and forty adult hemodialysis patients were monitored over 2 years; 83 were males and 57 females; 59% of the patients had diabetes mellitus. Twenty-nine patients (30.7%) were found to be in the high-risk group and 111 (79.3%) in the low-risk group. The high-risk patients were almost one and a half times more likely to be hospitalized for vascular access issues than the low-risk group (p = 0.056) and 3 times more likely to be hospitalized for non-vascular access issues than the low-risk group (p = 0.0001). The mortality rate in the high-risk group was 3.1 times that in the low-risk group, but this was not statistically significant. Conclusion: Using a simple and cheap assessment tool in hemodialysis patients, we have identified patients at high risk for hospitalization rates and mortality. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=490544.

Download Full-text

58 Effects of Access Type and Vintage on Hospitalization Rates in Hemodialysis Patients

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2018.02.064 ◽

2018 ◽

Vol 71 (4) ◽

pp. 529-530

Keyword(s):

Hemodialysis Patients ◽

Hospitalization Rates

Download Full-text

ASSOCIATION OF FACILITY-LEVEL SERUM PHOSPHATE WITH MORTALITY AND HOSPITALIZATION RATES IN HEMODIALYSIS PATIENTS

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2015.02.166 ◽

2015 ◽

Vol 65 (4) ◽

pp. A55

Keyword(s):

Hemodialysis Patients ◽

Serum Phosphate ◽

Hospitalization Rates ◽

Facility Level

Download Full-text

Infection-Related Hospitalizations in Home Hemodialysis Patients

Blood Purification ◽

10.1159/000433517 ◽

2015 ◽

Vol 40 (3) ◽

pp. 187-193 ◽

Cited By ~ 2

Author(s):

Shu-Hong Bi ◽

Wen Tang ◽

Nives Rigodanzo-Massey ◽

Bessie A. Young ◽

Christopher R. Blagg ◽

...

Keyword(s):

Cox Regression ◽

Journal Club ◽

Hemodialysis Patients ◽

Dialysis Access ◽

Home Hemodialysis ◽

Cox Regression Analysis ◽

Hospitalization Rates ◽

Dialysis Vintage ◽

System Data

Introduction and Aims: Infection is an important cause of hospitalization and death in patients receiving hemodialysis (HD). Few studies have examined infection-related hospitalizations in home HD (HHD) population. The purpose of this study was to examine the scope of infections and the effect of HHD modality (daily home HD (DHD) and conventional home HD (CHD)) on infection-related hospitalizations in HHD patients. Methods: The study was performed in a large cohort of HHD patients. Infection-related hospitalizations during July 1, 2005, and August 30, 2010, were abstracted from the centralized computer system. Data on demographics, dialysis vintage and dialysis modality were analyzed. Results: One hundred sixty-five patients were included. During a median follow-up of 5 years, infection-related hospitalizations were observed in approximately 35.8% of all hospitalizations, which was the first cause for hospitalization. Rates of non-access-related infections were observed to be higher than that of access-related infections (1.7:1). Rates (per 100 person-years) of soft-tissue infection, pneumonia and sepsis ranged from 0.85 to 1.82 in patients on HHD. Meanwhile, access-related infection was the main cause for access-related hospitalizations (34.8%). Cox regression analysis showed that the usage of different dialysis modalities was not associated with a high risk for infection-related hospitalizations in HHD patients. Conclusions: Infection-related hospitalization occurred frequently in HHD patients. A broad range of infections, many unrelated to dialysis access, resulted in hospitalization in this population. HHD modalities were not associated with infection-related hospitalizations in HHD patients. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=433517.

Download Full-text