Outcomes of Hemodialysis Patients in a Long-term Care Hospital Setting: A Single-Center Study
Received 7 April 2009; accepted 14 August 2009. published online 14 December 2009.
Refers to article:
Doc, Don't Procrastinate…Rehabilitate, Palliate, and Advocate
S. Vanita Jassal, Diane Watson
American Journal of Kidney Diseases
February 2010 (Vol. 55, Issue 2, Pages 209-212) Full Text |
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Background
Long-term care hospitals (LTCHs) provide intermediary care after an acute-care hospitalization and usually furnish care to patients with complex medical problems. Outcomes of hemodialysis patients admitted to LTCHs, which includes patients with either end-stage renal disease (ESRD) or acute kidney injury (AKI) requiring dialysis therapy, are not known.
Study Design
Observational study.
Setting & Participants
All consecutive hemodialysis patients admitted to an LTCH.
Predictors
Demographic characteristics, comorbid and laboratory variables, ESRD, and AKI status during LTCH stay.
Outcomes
Disposition from LTCHs was classified as discharge to home, nursing home, death in LTCH or hospice care, and re-admission to the hospital. In patients with AKI, renal recovery was defined as discontinuation of dialysis therapy before meeting disposition outcomes.
Results
96 of 206 (46.6%) patients had ESRD, whereas 110 of 206 (53.3%) developed AKI requiring dialysis therapy during the acute-care hospitalization. 63 of 206 (31%) were discharged to home, 11 of 206 (5.4%) died or transferred to hospice, 81 of 206 (40%) went to a nursing home, and 49 of 206 (24%) were re-admitted to a hospital; mortality after re-admission was 32%. Older age (OR, 0.96; 95% CI, 0.93-0.98), diabetes mellitus (OR, 0.45; 95% CI, 0.23-0.94), number of re-admissions to the hospital (OR, 0.38; 95% CI, 0.18-0.78), aminoglycoside use (OR, 0.16; 95% CI, 0.04-0.64), and duration of hospitalization before LTCH admission (OR, 0.96; 95% CI, 0.94-0.99) were associated with lower odds of discharge to home. Of 110 patients with AKI requiring dialysis therapy, 30% (33 patients) discontinued dialysis therapy, whereas 70% were deemed to have ESRD on discharge.
Limitations
Retrospective observational study.
Conclusions
Most dialysis patients at LTCHs are either re-admitted to acute-care hospitals or require nursing home placement. Only 30% of patients with AKI recover sufficiently to discontinue dialysis therapy, whereas 70% are deemed to have ESRD.
1Cincinnati VA Medical Center, University of Cincinnati, Cincinnati, OH
2Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
3Department of Public Health Sciences, University of Cincinnati, Cincinnati, OH
Address correspondence to Charuhas V. Thakar, MD, Division of Nephrology and Hypertension, University of Cincinnati, 231 Albert B Sabin Way, ML 0585, Cincinnati, OH 45242
ABSTRACT