Acute Care Hospitalizations Prior To Initiation of Dialysis Signal Greater Mortality Risk Interview with:
Charuhas Thakar, MD Professor

Director of the Division of Nephrology Kidney CARE program
University of Cincinnati What is the background for this study? What are the main findings?

Response: Based on the plausibility that pre-dialysis health status can impact outcomes after initiation of chronic dialysis, we examined large national USRDS dataset with linked Medicare claims prior to dialysis. We found that 88% of patients who initiate dialysis experience at least one acute care hospitalization in two years preceding their dialysis start.

If they do, that is associated with a significant increase in the risk of mortality at one year. We also examined effect of different types of hospitalizations in the pre-dialysis period – Cardiovascular, Infections, both, and neither of the two. There were statistical differences in the effect of type of hospitalization and post dialysis mortality. What should clinicians and patients take away from your report?

Response: Dialysis initiation is a time of transition of care for the patients, providers, payors, healthcare systems. It is common that the healthcare team that inherits the care of a dialysis patient upon initiation of dialysis may not recognize or have access to pre-dialysis hospitalization information. Our study makes a compelling case that everyone concerned in delivering dialysis care should pay attention to the course of events during acute care for at least 2 years prior to dialysis.

Simply stated, if a patient has experienced acute care admission prior to dialysis (cardiovascular or otherwise), we need to be vigilant and consider them as high risk of mortality within one year.

Lastly, dialysis industry is heavily regulated; and one year mortality in dialysis patients is considered as a quality parameter. Quality parameters in turn are linked to reimbursement. Our study strongly indicates that future comparisons of one year outcomes should consider pre-dialysis acute care utilizations in the case-mix adjustment. What recommendations do you have for future research as a result of this study?

Response: We need to identify specific risk factors based on patient level data. USRDS and Medicare only provide claims level data.

We also need to understand whether pre-dialysis hospitalizations and post-dialysis hospitalizations are linked or occur in the same group of patients? Is there anything else you would like to add?

Response: I would like to thank our team of researchers at UC who led or participated in this project. This project was supported from intra-mural research funds of the Division of Nephrology, Kidney CARE Program at the University f Cincinnati. Thank you for your contribution to the community.


Impact of Pre-Dialysis Hospitalizations on Outcomes Among Elderly Dialysis Patients
Thakar, Charuhas V , Leonard, Anthony C, Shah, Silvi,

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on November 4, 2017 by Marie Benz MD FAAD