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...
Gespeichert in:
| Veröffentlicht in: | Hemodialysis international 2021-10, Vol.25 (4), p.548-559 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 559 |
|---|---|
| container_issue | 4 |
| container_start_page | 548 |
| container_title | Hemodialysis international |
| container_volume | 25 |
| creator | Bellin, Eran Y. Hellebrand, Alice M. Kaplan, Steven M. Ledvina, Jordan G. Markis, William T. Levin, Nathan W. Kaufman, Allen M. |
| description | 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 |
| doi_str_mv | 10.1111/hdi.12943 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8596662</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2541784754</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4153-37e3076a6707aeb6949f6a47208dad97850a22fdec8bec0e7a234357746676823</originalsourceid><addsrcrecordid>eNp1kM9OwjAcgBujEUQPvoDZUQ-D_u92MSGAQkLiRc9NWTuo2da5Mg03H8In9EksgkQP9tKm_fL1lw-ASwT7KKzBSts-wiklR6CLGMUxFSw5Dmea4lgwwjrgzPtnCDGCkJ-CDqGIYEh4F4wntdWmtK5wy03k8qhqG2-rZbRypYm0VcXGWx_Vam1Ntfaf7x_DaGW1NlVUu7otwr2rzsFJrgpvLvZ7DzzdTR5H03j-cD8bDedxRhEjMRGGQMEVF1Aos-ApTXOuqMAw0UqnImFQYZxrkyULk0EjFCaUMCEo54InmPTA7c5bt4vS6CxM1KhC1o0tVbORTln596WyK7l0rzJhKed8K7jeCxr30hq_lqX1mSkKVRnXeokZRSIJ9WhAb3Zo1jjvG5MfvkFQbqvLUF1-Vw_s1e-5DuRP5gAMdsCbLczmf5Ocjmc75RcH8Y1O</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2541784754</pqid></control><display><type>article</type><title>Epidemiology of nursing home dialysis patients—A hidden population</title><source>Access via Wiley Online Library</source><source>MEDLINE</source><creator>Bellin, Eran Y. ; Hellebrand, Alice M. ; Kaplan, Steven M. ; Ledvina, Jordan G. ; Markis, William T. ; Levin, Nathan W. ; Kaufman, Allen M.</creator><creatorcontrib>Bellin, Eran Y. ; Hellebrand, Alice M. ; Kaplan, Steven M. ; Ledvina, Jordan G. ; Markis, William T. ; Levin, Nathan W. ; Kaufman, Allen M.</creatorcontrib><description>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 < 0.02).
Discussion
Provision of in‐SNF dialysis by an external dialysis organization enables discharge from the acute care setting for appropriate treatment with increased nursing contact time in an otherwise under‐resourced environment. SNF ESRD patient clinical characteristics and outcomes are extensively characterized for the first time.</description><identifier>ISSN: 1492-7535</identifier><identifier>EISSN: 1542-4758</identifier><identifier>DOI: 10.1111/hdi.12943</identifier><identifier>PMID: 34132036</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>epidemiology ; ESRD ; hemodialysis ; Hemodialysis, Home ; Humans ; intradialytic hypotension ; mortality risk factors ; nursing home ; Original ; ORIGINAL ARTICLES ; Patient Discharge ; Renal Dialysis ; Retrospective Studies ; Skilled Nursing Facilities</subject><ispartof>Hemodialysis international, 2021-10, Vol.25 (4), p.548-559</ispartof><rights>2021 The Authors. published by Wiley Periodicals LLC on behalf of International Society for Hemodialysis.</rights><rights>2021 The Authors. Hemodialysis International published by Wiley Periodicals LLC on behalf of International Society for Hemodialysis.</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4153-37e3076a6707aeb6949f6a47208dad97850a22fdec8bec0e7a234357746676823</citedby><cites>FETCH-LOGICAL-c4153-37e3076a6707aeb6949f6a47208dad97850a22fdec8bec0e7a234357746676823</cites><orcidid>0000-0002-1157-3627</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fhdi.12943$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fhdi.12943$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34132036$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bellin, Eran Y.</creatorcontrib><creatorcontrib>Hellebrand, Alice M.</creatorcontrib><creatorcontrib>Kaplan, Steven M.</creatorcontrib><creatorcontrib>Ledvina, Jordan G.</creatorcontrib><creatorcontrib>Markis, William T.</creatorcontrib><creatorcontrib>Levin, Nathan W.</creatorcontrib><creatorcontrib>Kaufman, Allen M.</creatorcontrib><title>Epidemiology of nursing home dialysis patients—A hidden population</title><title>Hemodialysis international</title><addtitle>Hemodial Int</addtitle><description>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 < 0.02).
Discussion
Provision of in‐SNF dialysis by an external dialysis organization enables discharge from the acute care setting for appropriate treatment with increased nursing contact time in an otherwise under‐resourced environment. SNF ESRD patient clinical characteristics and outcomes are extensively characterized for the first time.</description><subject>epidemiology</subject><subject>ESRD</subject><subject>hemodialysis</subject><subject>Hemodialysis, Home</subject><subject>Humans</subject><subject>intradialytic hypotension</subject><subject>mortality risk factors</subject><subject>nursing home</subject><subject>Original</subject><subject>ORIGINAL ARTICLES</subject><subject>Patient Discharge</subject><subject>Renal Dialysis</subject><subject>Retrospective Studies</subject><subject>Skilled Nursing Facilities</subject><issn>1492-7535</issn><issn>1542-4758</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kM9OwjAcgBujEUQPvoDZUQ-D_u92MSGAQkLiRc9NWTuo2da5Mg03H8In9EksgkQP9tKm_fL1lw-ASwT7KKzBSts-wiklR6CLGMUxFSw5Dmea4lgwwjrgzPtnCDGCkJ-CDqGIYEh4F4wntdWmtK5wy03k8qhqG2-rZbRypYm0VcXGWx_Vam1Ntfaf7x_DaGW1NlVUu7otwr2rzsFJrgpvLvZ7DzzdTR5H03j-cD8bDedxRhEjMRGGQMEVF1Aos-ApTXOuqMAw0UqnImFQYZxrkyULk0EjFCaUMCEo54InmPTA7c5bt4vS6CxM1KhC1o0tVbORTln596WyK7l0rzJhKed8K7jeCxr30hq_lqX1mSkKVRnXeokZRSIJ9WhAb3Zo1jjvG5MfvkFQbqvLUF1-Vw_s1e-5DuRP5gAMdsCbLczmf5Ocjmc75RcH8Y1O</recordid><startdate>202110</startdate><enddate>202110</enddate><creator>Bellin, Eran Y.</creator><creator>Hellebrand, Alice M.</creator><creator>Kaplan, Steven M.</creator><creator>Ledvina, Jordan G.</creator><creator>Markis, William T.</creator><creator>Levin, Nathan W.</creator><creator>Kaufman, Allen M.</creator><general>John Wiley & Sons, Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-1157-3627</orcidid></search><sort><creationdate>202110</creationdate><title>Epidemiology of nursing home dialysis patients—A hidden population</title><author>Bellin, Eran Y. ; Hellebrand, Alice M. ; Kaplan, Steven M. ; Ledvina, Jordan G. ; Markis, William T. ; Levin, Nathan W. ; Kaufman, Allen M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4153-37e3076a6707aeb6949f6a47208dad97850a22fdec8bec0e7a234357746676823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>epidemiology</topic><topic>ESRD</topic><topic>hemodialysis</topic><topic>Hemodialysis, Home</topic><topic>Humans</topic><topic>intradialytic hypotension</topic><topic>mortality risk factors</topic><topic>nursing home</topic><topic>Original</topic><topic>ORIGINAL ARTICLES</topic><topic>Patient Discharge</topic><topic>Renal Dialysis</topic><topic>Retrospective Studies</topic><topic>Skilled Nursing Facilities</topic><toplevel>online_resources</toplevel><creatorcontrib>Bellin, Eran Y.</creatorcontrib><creatorcontrib>Hellebrand, Alice M.</creatorcontrib><creatorcontrib>Kaplan, Steven M.</creatorcontrib><creatorcontrib>Ledvina, Jordan G.</creatorcontrib><creatorcontrib>Markis, William T.</creatorcontrib><creatorcontrib>Levin, Nathan W.</creatorcontrib><creatorcontrib>Kaufman, Allen M.</creatorcontrib><collection>Wiley Online Library (Open Access Collection)</collection><collection>Wiley Online Library (Open Access Collection)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Hemodialysis international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bellin, Eran Y.</au><au>Hellebrand, Alice M.</au><au>Kaplan, Steven M.</au><au>Ledvina, Jordan G.</au><au>Markis, William T.</au><au>Levin, Nathan W.</au><au>Kaufman, Allen M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Epidemiology of nursing home dialysis patients—A hidden population</atitle><jtitle>Hemodialysis international</jtitle><addtitle>Hemodial Int</addtitle><date>2021-10</date><risdate>2021</risdate><volume>25</volume><issue>4</issue><spage>548</spage><epage>559</epage><pages>548-559</pages><issn>1492-7535</issn><eissn>1542-4758</eissn><abstract>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 < 0.02).
Discussion
Provision of in‐SNF dialysis by an external dialysis organization enables discharge from the acute care setting for appropriate treatment with increased nursing contact time in an otherwise under‐resourced environment. SNF ESRD patient clinical characteristics and outcomes are extensively characterized for the first time.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>34132036</pmid><doi>10.1111/hdi.12943</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-1157-3627</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1492-7535 |
| ispartof | Hemodialysis international, 2021-10, Vol.25 (4), p.548-559 |
| issn | 1492-7535 1542-4758 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8596662 |
| source | Access via Wiley Online Library; MEDLINE |
| subjects | epidemiology ESRD hemodialysis Hemodialysis, Home Humans intradialytic hypotension mortality risk factors nursing home Original ORIGINAL ARTICLES Patient Discharge Renal Dialysis Retrospective Studies Skilled Nursing Facilities |
| title | Epidemiology of nursing home dialysis patients—A hidden population |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-25T16%3A04%3A15IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Epidemiology%20of%20nursing%20home%20dialysis%20patients%E2%80%94A%20hidden%20population&rft.jtitle=Hemodialysis%20international&rft.au=Bellin,%20Eran%20Y.&rft.date=2021-10&rft.volume=25&rft.issue=4&rft.spage=548&rft.epage=559&rft.pages=548-559&rft.issn=1492-7535&rft.eissn=1542-4758&rft_id=info:doi/10.1111/hdi.12943&rft_dat=%3Cproquest_pubme%3E2541784754%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2541784754&rft_id=info:pmid/34132036&rfr_iscdi=true |