Relationship of Missed and Shortened Hemodialysis Treatments to Hospitalization and Mortality: Observations from a US Dialysis Network

Overview

Journal Clin Kidney J

Publisher Oxford University Press

Specialty Nephrology

Date 2015 Apr 16

PMID 25874087

Citations 18

Authors

Chamberlain I Obialo

William C Hunt

Khalid Bashir

Phillip G Zager

Affiliations

Soon will be listed here.

Abstract

Background: The relationship of missed and shortened hemodialysis (HD) to clinical outcomes has not been well characterized in HD patients in the USA. Here we explored the frequency of missed and shortened treatments and their impact on mortality and hospitalization.

Methods: A retrospective review of data from a cohort of 15 340 HD patients treated in facilities operated by Dialysis Clinics, Inc. We compared the frequency of missed and shortened treatments by gender, race, age and treatment schedules [Mondays, Wednesdays, Fridays (MWF) versus Tuesdays, Thursdays, Saturdays (TTS)].

Results: Of the 15 340 patients, 48% were non-Hispanic whites (NHWs), 41% African Americans (AAs), 6% Hispanics, 2% Native American (NA), 2% Asians and 1% other races. The median number of years on HD was 1.8 years and the median follow-up was 12.4 months. The odds of missing at least one treatment in a month were higher in: patients aged <55 years, odds ratio (OR) 1.33 (P<0.0001); in AAs, OR 1.51 (P < 0.0001); in NAs, OR 1.50 (P = 0.0003); and in Hispanics, OR 1.33 (P = 0.0003) compared with NHWs and in patients who dialyzed on TTS compared with MWF, OR 1.33 (P < 0.0001). Similar findings were observed for treatments shortened by at least 10 min per month. Missed and shortened treatments were most prevalent on Saturdays and were also associated with progressive increases in hospitalization and mortality.

Conclusion: Missed and shortened HD treatments pose a challenge to providers. Improved adherence to prescribed dialysis may decrease the morbidity and mortality.

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References

Teraoka S, Toma H, Nihei H, Ota K, Babazono T, Ishikawa I . Current status of renal replacement therapy in Japan. Am J Kidney Dis. 1995; 25(1):151-64. DOI: 10.1016/0272-6386(95)90640-1. View

Unruh M, Evans I, Fink N, Powe N, Meyer K . Skipped treatments, markers of nutritional nonadherence, and survival among incident hemodialysis patients. Am J Kidney Dis. 2005; 46(6):1107-16. DOI: 10.1053/j.ajkd.2005.09.002. View

Ifudu O, PAUL H . Effect of missed hemodialysis treatments on mortality in patients with end-stage renal disease. Nephron. 1998; 79(3):385-6. DOI: 10.1159/000045082. View

Block G, Port F . Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendations for a change in management. Am J Kidney Dis. 2000; 35(6):1226-37. DOI: 10.1016/s0272-6386(00)70064-3. View

Cukor D, Cohen S, Peterson R, Kimmel P . Psychosocial aspects of chronic disease: ESRD as a paradigmatic illness. J Am Soc Nephrol. 2007; 18(12):3042-55. DOI: 10.1681/ASN.2007030345. View

Kimmel P . Psychosocial factors in adult end-stage renal disease patients treated with hemodialysis: correlates and outcomes. Am J Kidney Dis. 2000; 35(4 Suppl 1):S132-40. DOI: 10.1016/s0272-6386(00)70240-x. View

Collins A, Foley R, Gilbertson D, Chen S . The state of chronic kidney disease, ESRD, and morbidity and mortality in the first year of dialysis. Clin J Am Soc Nephrol. 2009; 4 Suppl 1:S5-11. DOI: 10.2215/CJN.05980809. View

Saran R, Bragg-Gresham J, Rayner H, Goodkin D, Keen M, van Dijk P . Nonadherence in hemodialysis: associations with mortality, hospitalization, and practice patterns in the DOPPS. Kidney Int. 2003; 64(1):254-62. DOI: 10.1046/j.1523-1755.2003.00064.x. View

Tijerina M . Mexican American women's adherence to hemodialysis treatment: a social constructivist perspective. Soc Work. 2009; 54(3):232-42. DOI: 10.1093/sw/54.3.232. View

10.

Goodkin D, Bragg-Gresham J, Koenig K, Wolfe R, Akiba T, Andreucci V . Association of comorbid conditions and mortality in hemodialysis patients in Europe, Japan, and the United States: the Dialysis Outcomes and Practice Patterns Study (DOPPS). J Am Soc Nephrol. 2003; 14(12):3270-7. DOI: 10.1097/01.asn.0000100127.54107.57. View

11.

Cukor D, Rosenthal D, Jindal R, Brown C, Kimmel P . Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients. Kidney Int. 2009; 75(11):1223-1229. DOI: 10.1038/ki.2009.51. View

12.

Bleyer A, Hylander B, Sudo H, Nomoto Y, de la Torre E, Chen R . An international study of patient compliance with hemodialysis. JAMA. 1999; 281(13):1211-3. DOI: 10.1001/jama.281.13.1211. View

13.

Cheung A, Sarnak M, Yan G, Berkoben M, Heyka R, Kaufman A . Cardiac diseases in maintenance hemodialysis patients: results of the HEMO Study. Kidney Int. 2004; 65(6):2380-9. DOI: 10.1111/j.1523-1755.2004.00657.x. View

14.

Ward M . Socioeconomic status and the incidence of ESRD. Am J Kidney Dis. 2008; 51(4):563-72. DOI: 10.1053/j.ajkd.2007.11.023. View

15.

Lynch K, Lynch R, Curhan G, Brunelli S . Prescribed dietary phosphate restriction and survival among hemodialysis patients. Clin J Am Soc Nephrol. 2010; 6(3):620-9. PMC: 3082422. DOI: 10.2215/CJN.04620510. View

16.

Kovac J, Patel S, Peterson R, Kimmel P . Patient satisfaction with care and behavioral compliance in end-stage renal disease patients treated with hemodialysis. Am J Kidney Dis. 2002; 39(6):1236-44. DOI: 10.1053/ajkd.2002.33397. View

17.

Held P, Brunner F, Odaka M, Garcia J, Port F, Gaylin D . Five-year survival for end-stage renal disease patients in the United States, Europe, and Japan, 1982 to 1987. Am J Kidney Dis. 1990; 15(5):451-7. DOI: 10.1016/s0272-6386(12)70363-3. View

18.

Brownbridge G, Fielding D . Psychosocial adjustment and adherence to dialysis treatment regimes. Pediatr Nephrol. 1994; 8(6):744-9. DOI: 10.1007/BF00869109. View

19.

Kutner N, Zhang R, McClellan W, Cole S . Psychosocial predictors of non-compliance in haemodialysis and peritoneal dialysis patients. Nephrol Dial Transplant. 2002; 17(1):93-9. DOI: 10.1093/ndt/17.1.93. View

20.

Obialo C . Cardiorenal consideration as a risk factor for heart failure. Am J Cardiol. 2007; 99(6B):21D-24D. DOI: 10.1016/j.amjcard.2006.12.016. View