Older patients treated with maintenance dialysis spend more days in the hospital and receive intensive care more often than similar patients not treated with dialysis, new study findings suggest.

In a study of 968 patients older than 65 years from Alberta, Canada, with an estimated glomerular filtration rate of less than 10 mL/min/1.73 m2, 58% initiated maintenance hemodialysis or peritoneal dialysis and 43% did not. Dialysis patients spent 22 more cumulative days in hospital each year (36.25 vs 14.65 days), Brenda R. Hemmelgarn, MD, PhD, of the University of Calgary, and colleagues reported in JAMA Network Open. This trend held even when the investigators excluded patients with in-hospital dialysis starts and prior hospitalizations.

In addition, dialysis patients were nearly twice as likely to receive intensive care (98.4 vs 54.5 intensive care unit admissions per 1000 hospitalizations), but they were less likely to receive inpatient palliative care (3.9 vs 8.6 per 1000 in-hospital days). The incidence of emergency department visits, long-term care admissions, and cardiopulmonary resuscitation episodes was similar between groups. Dialysis patients, however, were 3 times as likely to die in a hospital.

Dialysis-specific complications such as infection as well as structural issues and overarching philosophy of care may explain the extra days that dialysis patients spend in the hospital, according to the investigators. This study adds to the literature because it was not restricted to patients referred to nephrology.


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“Although a previous study found that maintenance dialysis may reduce the risk of mortality within the first 3 years of kidney failure, this present study suggests that dialysis may be associated with an increase in time that patients spent in the hospital as well as receipt of more intensive health care services,” Dr Hemmelgarn’s team stated. “From a patient perspective, future work should investigate prospective data and integrate estimates of survival, time spent in the hospital, and intensity of care in a personalized decision aid to communicate potential trade-offs and support shared treatment decision-making.”

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Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Tam-Tham H, Ravani P, Zhang J, et al. Association of initiation of dialysis with hospital length of stay and intensity of care in older adults with kidney failure. JAMA Netw Open. 2020;3(2):e200222. doi: 10.1001/jamanetworkopen.2020.0222