Epidemiology of nursing home dialysis patients—A hidden population
Introduction Dialysis patients are often discharged from hospitals to skilled nursing facilities (SNFs), but little has been published about their natural history. Methods Using electronic medical record data, we conducted a retrospective cohort study of nursing home patients treated with in‐SNF hem...
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Veröffentlicht in: | Hemodialysis international 2021-10, Vol.25 (4), p.548-559 |
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Sprache: | eng |
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Zusammenfassung: | Introduction
Dialysis patients are often discharged from hospitals to skilled nursing facilities (SNFs), but little has been published about their natural history.
Methods
Using electronic medical record data, we conducted a retrospective cohort study of nursing home patients treated with in‐SNF hemodialysis from January 1, 2018 through June 20, 2020 within a dialysis organization across eight states. A dialytic episode began with the first in‐SNF dialysis and was ended by hospitalization, death, transfer, or cessation of treatment. The clinical characteristics and natural history of these patients and their dialytic episodes are described.
Findings
Four thousand five hundred and ten patients experienced 9274 dialytic episodes. Dialytic episodes had a median duration of 18 days (IQR: 8–38) and were terminated by a hospitalization n = 5747 (62%), transfer n = 2638 (28%), death n = 568 (6%), dialysis withdrawal n = 129 (1.4%), recovered function n = 2 (0.02%), or other cause n = 6 (0.06%). Increased patient mortality was associated with advancing age, low serum creatinine, albumin, or sodium, and low pre‐dialytic systolic blood pressure (sBP). U‐shaped relationships to mortality were observed for intradialytic hypotension frequency and for post‐ > pre‐hemodialysis sBP frequency. Prescription of dialysis five times weekly in the first 2 weeks was associated with better survival in the first 90 days (HR 0.77, CI 0.62–0.96; p |
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ISSN: | 1492-7535 1542-4758 |
DOI: | 10.1111/hdi.12943 |