Published in:
01-11-2017 | Original Research
Hospitalizations and Nursing Facility Stays During the Transition from CKD to ESRD on Dialysis: An Observational Study
Published in: Journal of General Internal Medicine | Issue 11/2017
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Background
There is little information on hospital and nursing facility stays during the transition from pre-dialysis kidney disease to end-stage renal disease treated with dialysis.
Objectives
To examine hospital and nursing facility stays in the years pre- and post-dialysis initiation, and to develop a novel method for visualizing these data.
Design
Observational study of patients in the US Renal Data System initiating dialysis from October 2011 to October 2012.
Participants
Patients aged ≥67 years with Medicare Part A/B coverage for 1 year pre-dialysis initiation.
Main Measures
Proportion of patients with ≥1 facility day, and among these, the mean number of days and the mean proportion of time spent in a facility in the first year post-dialysis initiation. We created “heat maps” to represent data visually.
Key Results
Among 28,049 patients, > 60% initiated dialysis in the hospital. Patients with at least 1 facility day spent 37–42 days in a facility in the year pre-dialysis initiation and 59–67 facility days in the year post-dialysis initiation. The duration of facility stay varied by age: patients aged 67–70 years spent 60 (95% CI 57–62) days or 25.8% of the first year post-dialysis initiation in a facility, while patients aged >80 years spent 67 (CI 65–69) days or 36.8% of the first year post-dialysis initiation in a facility. Patterns varied depending on the presence or absence of certain comorbid conditions, with dementia having a particularly large effect: patients with dementia spent approximately 50% of the first year post-dialysis initiation in a facility, regardless of age.
Conclusions
Older patients, particularly octogenarians and patients with dementia or other comorbidities, spend a large proportion of time in a facility during the first year after dialysis initiation. Our heat maps provide a novel and concise visual representation of a large amount of quantitative data regarding expected outcomes after initiation of dialysis.