Cause of admission found to affect risk.
SAN FRANCISCO—Dialysis patients hospitalized for infection, GI bleeding, or a major surgical procedure may experience a significant decline in hematocrit (Hct) levels, researchers say. The decline increases with length of stay.
“This study is important because it has strong implications for dialysis facilities and outpatient units that are treating patients upon return from a hospitalization,” said investigator Marc Turenne, PhD, assistant research scientist at the University of Michigan in Ann Arbor. “These patients are returning with a significantly lower hematocrit and they need to know that the cause of hospitalization and duration of hospitalization may have an effect.”
Previous studies have shown that hospitalization is linked to lower Hct and significantly higher health-care costs for erythropoiesis-stimulating agents (ESAs) and other services in dialysis patients. It is believed that Hct levels may be affected by several aspects of inpatient care, including how inpatient providers manage anemia and the cause and duration of hospitalization.
Dr. Turenne and his colleagues used Medicare outpatient claims in 2004 to calculate the change in Hct levels between the month before and the month after admission for 136,233 hemodialysis patient months with inpatient stays of three days or more. For this study, the researchers used diagnosis-related groups (DRGs) to categorize admissions into high risk of anemia (infection, GI bleeding, or surgical procedure) compared with other admissions.
The researchers examined the DRG category and inpatient days as predictors of Hct with adjustments for Hct and epoetin alfa use in the month before admission. They also adjusted for age, gender, and body size.
Hct declined an average of 1.1% among patients in the study. The decline was approximately 0.7% larger for patients having an admission with a high risk for anemia (average decline of 1.4%) than for patients with no such admission (average decline of 0.7%).
The Hct decreased with the number of inpatient days for both types of admissions. Hct levels varied across both hospitals and physicians. While there was little or no decline in Hct for some providers, larger declines in Hct (for example, an average change of at least -2.0%) were observed for other providers.
Dr. Turenne, who reported study findings here during Renal Week 2007, said a decline in Hct due to hospitalization and variation in the management of Hct levels by inpatient providers are important issues that need to be further analyzed. He said these two issues may have financial implications for dialysis facilities under a more broadly bundled Medicare payment system that includes ESAs. Study findings also un-derscore the need for close monitoring of Hct levels in all hemodialysis patients both during and following hospitalization.
“These patterns we are seeing might be helpful in guiding anemia management care. For nephrologists who are treating the patients when they return to the unit this information may be helpful because it points out that patients who have been hospitalized are likely to need higher levels of care.”