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- Title
Hospitalizations and Nursing Facility Stays During the Transition from CKD to ESRD on Dialysis: An Observational Study.
- Authors
Montez-Rath, Maria; Zheng, Yuanchao; Tamura, Manjula; Grubbs, Vanessa; Winkelmayer, Wolfgang; Chang, Tara; Montez-Rath, Maria E; Tamura, Manjula Kurella; Winkelmayer, Wolfgang C; Chang, Tara I
- Abstract
<bold>Background: </bold>There is little information on hospital and nursing facility stays during the transition from pre-dialysis kidney disease to end-stage renal disease treated with dialysis.<bold>Objectives: </bold>To examine hospital and nursing facility stays in the years pre- and post-dialysis initiation, and to develop a novel method for visualizing these data.<bold>Design: </bold>Observational study of patients in the US Renal Data System initiating dialysis from October 2011 to October 2012.<bold>Participants: </bold>Patients aged ≥67 years with Medicare Part A/B coverage for 1 year pre-dialysis initiation.<bold>Main Measures: </bold>Proportion of patients with ≥1 facility day, and among these, the mean number of days and the mean proportion of time spent in a facility in the first year post-dialysis initiation. We created "heat maps" to represent data visually.<bold>Key Results: </bold>Among 28,049 patients, > 60% initiated dialysis in the hospital. Patients with at least 1 facility day spent 37-42 days in a facility in the year pre-dialysis initiation and 59-67 facility days in the year post-dialysis initiation. The duration of facility stay varied by age: patients aged 67-70 years spent 60 (95% CI 57-62) days or 25.8% of the first year post-dialysis initiation in a facility, while patients aged >80 years spent 67 (CI 65-69) days or 36.8% of the first year post-dialysis initiation in a facility. Patterns varied depending on the presence or absence of certain comorbid conditions, with dementia having a particularly large effect: patients with dementia spent approximately 50% of the first year post-dialysis initiation in a facility, regardless of age.<bold>Conclusions: </bold>Older patients, particularly octogenarians and patients with dementia or other comorbidities, spend a large proportion of time in a facility during the first year after dialysis initiation. Our heat maps provide a novel and concise visual representation of a large amount of quantitative data regarding expected outcomes after initiation of dialysis.
- Subjects
UNITED States; KIDNEY disease treatments; HEMODIALYSIS; KIDNEY disease diagnosis; KIDNEY diseases; DIALYSIS facilities; PATIENTS; TREATMENT of chronic kidney failure; AGE distribution; CHRONIC kidney failure; HOSPITAL care; NURSING care facilities; RESEARCH funding; DISEASE progression; DIAGNOSIS
- Publication
JGIM: Journal of General Internal Medicine, 2017, Vol 32, Issue 11, p1220
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-017-4151-6