MedicalResearch.com Interview with:
Dr. Csaba P. Kovesdy
Fred Hatch Professor of Medicine
Director, Clinical Outcomes and Clinical Trials Program
Division of Nephrology, University of Tennessee Health Science Center
Nephrology Section Chief, Memphis VA Medical Center
Memphis TN, 38163
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Many ESRD patients initiate dialysis in an inpatient setting. This practice is expensive, and carries potential risks (e.g. hospital associated infections, medication errors, etc.). There is very little information about the characteristics of patients who transition to ESRD (i.e. start dialysis) in an inpatient setting, and about their outcomes.
We examined a cohort of >50,000 US veterans who started dialysis during 2007-2011, and found that about half of them performed their first treatment in an inpatient setting. Compared to patients starting dialysis as outpatients, those who transitioned in an inpatient setting had a significantly higher prevalence of comorbid conditions, and were much less likely to have received pre-dialysis nephrology care, or to have a mature AV fistula or AV graft at the first hemodialysis treatment. Mortality was significantly higher in the inpatient start group, but the differences were attenuated by adjustment for comorbid conditions and vascular access.
MedicalResearch.com: What should readers take away from your report?
Response: Some of the characteristics that determine the need to start dialysis in an inpatient setting are correctable (such as pre-dialysis nephrology care and a mature AV fistula). It is thus possible that earlier nephrology referral of patients with advanced CKD, and timely creation of an AVF or AVG could make it possible to initiate dialysis electively in an outpatient setting. Based on our findings it is possible that this could lead not only to cost savings, but also better survival.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We need prospective studies to determine if actions such as early nephrology referral and timely creation of an AVF or AVG could indeed improve the outcomes of dialysis patients by virtue of fewer hospital-based dialysis transitions.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Citation: upcoming ASN abstract:
Outcomes Associated with Inpatient versus Outpatient Hemodialysis Initiation in a Large Incident ESRD Cohort
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