Association of Dialyzer Reuse and Hospitalization Rates among Hemodialysis Patients in the US

Objectives: Because inter- and intra-country variations in the adoption of medical technologies exist, international comparative studies provide an opportunity to infer technology effectiveness. Few studies have characterized recent trends in acute myocardial infarction (AMI) management between countries. Methods: Repeated cross-sectional observational cohorts of hospitalized adults aged ≥20 years discharged between January 2000 and December 2010. We identified new AMI hospitalizations using a US national 20% inpatient sample and a 100% inpatient sample in all Portuguese public sector hospitals. Age, sex, comorbidities, and median length of stay (interquartile range [IQR]) were determined. Annual age-sex adjusted hospitalization rates (HR) for AMI, in-hospital procedures, and in-hospital mortality were directly standardized to the 2010 US population. Intra-country (2010 relative to 2000) and inter-country in 2010 (Portugal [PT] relative to US) rate ratios [RR] were estimated. Findings: We identified 1476808 AMI US hospitalizations and 126314 Portugal hospitalizations between 2000 and 2010. Portuguese patients were more male, younger, and had fewer comorbidities compared to US patients (Table). The age-sex adjusted AMI HR decreased from 21 per 1000 person-years to 15 in the US (RR=0.70; 95% CI = [0.70, 0.71]) but increased in PT (14 to 15 per 1000, RR = 1.17 [1.14, 1.21]). While crude procedure rates were uniformly lower in PT, only CABG rates differed after standardization (2010: RR=0.19 [0.14, 0.26]). PCI use increased annually in both countries and decreased for CABG in the US only (102 to 79, RR=0.77 [0.73, 0.81]). Standardized in-hospital mortality decreased within-country (US: 44 to 29 per 1000, RR= 0.65 [0.60, 0.72]; PT: 93 to 62 per 1000, RR= 0.67 [0.44, 1.00]). In 2010, PT mortality was twice that in the US. Conclusions: AMI hospitalization rates and use of medical technologies are higher in the US compared to Portugal. However, standardized rates reveal only CABG surgery rates differ significantly between the two countries. Outcomes, measured by hospital mortality and LOS, are generally better in the U.S. Inter-country disparities may be a consequence of differential use of technologies, differences in AMI epidemiology, patient risk, or quality of hospital billing data.

Download Full-text

MO739EX VIVO THROMBOCYTE FUNCTION IN HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab097.0019 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Vera Bonell ◽

Georg Lorenz ◽

Thorsten Kessler ◽

Uwe Heemann ◽

Christoph Schmaderer ◽

...

Keyword(s):

Infectious Disease ◽

Clinical Outcome ◽

Platelet Function ◽

Primary Endpoint ◽

Hemodialysis Patients ◽

Healthy Controls ◽

Induce Platelet Aggregation ◽

Platelet Counts ◽

Hospitalization Rates ◽

Multiplate Analyzer

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

PIN88 - HOSPITALIZATION RATES AMONG EMERGENCY ROOM-DIAGNOSED HIV+ PATIENTS IN THE US AND EU5

Value in Health ◽

10.1016/j.jval.2018.09.1407 ◽

2018 ◽

Vol 21 ◽

pp. S235-S236

Author(s):

S. Heinz ◽

J. Spindel ◽

D. Rogers

Keyword(s):

Emergency Room ◽

Hiv Patients ◽

Hospitalization Rates ◽

The Us

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

Provision of Kidney Disease Education Service is Associated with Improved Vascular Access Outcomes among the US Incident Hemodialysis Patients

Kidney360 ◽

10.34067/kid.0004502021 ◽

2021 ◽

pp. 10.34067/KID.0004502021

Author(s):

Rupam Ruchi ◽

Shahab Bozorgmehri ◽

Gajapathiraju Chamarthi ◽

Tatiana Orozco ◽

Rajesh Mohandas ◽

...

Keyword(s):

Kidney Disease ◽

Vascular Access ◽

Venous Catheter ◽

Hemodialysis Patients ◽

The Us ◽

Nephrology Care ◽

Stage Renal Disease ◽

End Stage ◽

The Impact ◽

Encompassing Model

Background: Pre-end stage renal disease (ESRD) Kidney Disease Education (KDE) has been shown to improve multiple chronic kidney disease (CKD) outcomes but, its impact on vascular access outcomes is not well-studied. In 2010, Medicare launched KDE reimbursements policy for patients with advanced CKD. Methods: In this retrospective USRDS analysis, we identified all adult incident hemodialysis patients with a minimum of 6-months of pre-ESRD Medicare coverage during the first five-years of CMS-KDE policy and divided them into CMS-KDE services recipients (KDE-cohort) and non-recipients (non-KDE cohort). The primary outcome was incident arteriovenous fistula (AVF) and the composite of incident AVF or arteriovenous graft (AVG) utilization. Secondary outcomes were central venous catheter (CVC) with maturing AVF/AVG and pure CVC utilizations. Step-wise multivariate analyses were performed in four progressive models (model 1: KDE alone, model 2: multivariate model encompassing model 1 with socio-demographics, model 3: model 2 with comorbidity and functional status, and model 4: model 3 with pre-ESRD nephrology care). Results: Of the 211,990 qualifying incident hemodialysis patients during the study period, 2,887(1.4%) received KDE services before dialysis initiation. The rates of incident AVF and composite AVF/AVG were more than double (29.7% and 34.9% respectively, compared to 14.2% and 17.2%) and pure catheter use about a third lower (40.4% compared to 64.5%) in the KDE cohort compared to the non-KDE cohort. Maximally adjusted odds ratio(99% confidence interval) in model 4 for study outcomes were: incident AVF use: 1.78 (1.55-2.05), incident AVF/AVG use: 1.78 (1.56-2.03), incident CVC with maturing AVF/AVG: 1.69 (1.44-1.97)and pure CVC without any AVF/AVG: 0.51 (0.45-0.58). The benefits of KDE service were maintained even after accounting for the presence, duration and facility of ESRD care. Conclusion: Occurrence of pre-ESRD KDE service is associated with significantly improved incident vascular access outcomes. Targeted studies are needed to examine the impact of KDE on patient engagement and self-efficacy as a cause for improvement in vascular access outcomes.

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

Abstract T P137: Temporal Trends in Hospitalization for Ischemic Stroke in the United States, 2000-2010

Stroke ◽

10.1161/str.45.suppl_1.tp137 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Nerses Sanossian ◽

May A Kim-Tenser ◽

Lucas Ramirez ◽

Natalie Valle ◽

Steven Cen ◽

...

Keyword(s):

Ischemic Stroke ◽

Black Women ◽

Temporal Trends ◽

The United States ◽

Population Based ◽

Older Individuals ◽

Hospitalization Rates ◽

The Us ◽

Age Adjusted Rates ◽

Age And Sex

Background: Recent population-based studies have revealed declining ischemic stroke hospitalization rates in the US, particularly among whites, but no study has assessed recent nationwide trends in race/ethnic-, age- and sex-specific stroke hospitalization rates in the US. Aims: To assess temporal trends in race/ethnic-, age-, and sex-specific rates of hospitalization for ischemic stroke in the US. Methods: Temporal trends in hospitalization for ischemic stroke (ICD-9 codes 433.x1, 434, 436) from 2000 to 2010 were assessed among adults ≥25 years using the Nationwide Inpatient Sample. Age-, sex-, and race/ethnic-specific stroke hospitalization rates were calculated using the weighted number of hospitalizations as the numerator and the US civilian population as the denominator. Age-adjusted rates were standardized to the 2000 US Census population. Results: From 2000 to 2010, age-adjusted stroke hospitalization rates decreased from 169 to 138 per 100,000 (overall rate reduction 18.3%). The decline in stroke hospitalizations was driven by the ≥65 age group, with the sharpest decline among 65-84 year olds (Figure). Sex-specific rates showed higher age-adjusted rates in women, with a steeper reduction in women than in men (from 228 to 180 vs. 183 to 157 per 100,000). Race/ethnic-specific trends revealed that hospitalizations decreased for whites and Hispanics but increased for blacks (from 144 to 193 per 100,000 in black men and from 191 to 211 per 100,000 in black women). Discussion: Although overall stroke hospitalizations have decreased in the US, the reduction has been more pronounced among older individuals, whites and Hispanics. Renewed efforts at targeting risk factor control among blacks and middle-aged individuals may be warranted. Figure 1.

Download Full-text

Abstract 50: Persistent Racial/Ethnic Disparities Despite Declining Rates of Ischemic Stroke Hospitalizations Among Medicare Beneficiaries, 2001-2013

Stroke ◽

10.1161/str.48.suppl_1.50 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Judith H Lichtman ◽

Erica C Leifheit-Limson ◽

Yun Wang ◽

Tatjana Rundek ◽

Larry B Goldstein ◽

...

Keyword(s):

Ischemic Stroke ◽

Ethnic Groups ◽

Mixed Model ◽

Systems Of Care ◽

Ethnic Disparities ◽

Fee For Service ◽

Hospitalization Rates ◽

The Us ◽

Race Ethnicity ◽

Racial Ethnic

Background: Stroke hospitalizations in the US have declined over the last decade, but little is known about whether decreases are similar across racial/ethnic groups. We compared ischemic stroke hospitalization rates and geographic patterns across the US from 2001-2013 for elderly Hispanics, Blacks, Whites, and those of other race/ethnicity. Methods: Ischemic stroke hospitalizations (ICD-9 primary discharge codes 433, 434, 436) were identified among Medicare fee-for-service beneficiaries aged ≥65y in 2001-2003 and 2011-2013. National annualized rates for each period were calculated per 100,000 person-years (PY). A spatial mixed model with a Poisson link function and adjustment for age and sex was fit to calculate and map county-specific risk-standardized stroke hospitalization rates for each racial/ethnic group. Results: National annualized stroke hospitalization rates decreased by 15% between 2001-2003 and 2011-2013 (1298/100,000 PY to 1103/100,000 PY). County-level risk-standardized hospitalization rates varied across the US and among the four racial/ethnic groups (figure). Regardless of time period, Blacks had the highest rates, followed by Whites, Hispanics, and other races. The absolute and relative declines in risk-standardized hospitalization rates were smallest for Hispanics (173/100,000 PY; 15%) and Blacks (196/100,000 PY; 12%) compared to Whites (243/100,000 PY; 19%) and other races (273/100,000 PY; 33%). Conclusions: Although national hospitalization rates for ischemic stroke among those aged ≥65y decreased between 2001 and 2013, the decline varied by race/ethnicity, with persistent disparities between groups. Despite the declines in US stroke hospitalizations, these racial/ethnic differences call for greater prioritization of prevention intervention programs to reduce stroke disparities. AHA/ASA efforts to expand stroke systems of care also need to address these disparities.

Download Full-text