Risk factors for infection-related hospitalization in in-center hemodialysis

Lorien Dalrymple, Yi Mu, Danh V. Nguyen, Patrick S Romano, Glenn M. Chertow, Barbara Grimes, George Kaysen, Kirsten L. Johansen

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background and objectives Infection-related hospitalizations have increased dramatically over the last 10 years in patients receiving in-center hemodialysis. Patient and dialysis facility characteristics associated with the rate of infection-related hospitalization were examined, with consideration of the region of care, rural-urban residence, and socioeconomic status. Design, setting, participants, & measurements The US Renal Data System linked to the American Community Survey and Rural-Urban Commuting Area codes was used to examine factors associated with hospitalization for infection among Medicare beneficiaries starting in-center hemodialysis between 2005 and 2008. A Poisson mixed effects model was used to examine the associations among patient and dialysis facility characteristics and the rate of infection-related hospitalization. Results Among 135,545 Medicare beneficiaries, 38,475 (28%) had at least one infection-related hospitalization. The overall rate of infection-related hospitalization was 40.2 per 100 person-years. Age ≥85 years old, cancer, chronic obstructive pulmonary disease, inability to ambulate or transfer, drug dependence, residence in a care facility, serum albumin < 3.5 g/dl at dialysis initiation, and dialysis initiation with an access other than a fistula were associated with a ≥20% increase in the rate of infection-related hospitalization. Patients residing in isolated small rural compared with urban areas had lower rates of hospitalization for infection (rate ratio, 0.91; 95% confidence interval, 0.86 to 0.97), and rates of hospitalization for infection varied across the ESRD networks. Measures of socioeconomic status (at the zip code level), total facility staffing, and the composition of staff (percentage of nurses) were not associated with the rate of hospitalization for infection. Conclusions Patient and facility factors associated with higher rates of infection-related hospitalization were identified. The findings from this study can be used to identify patients at higher risk for infection and inform the design of infection prevention strategies.

Original languageEnglish (US)
Pages (from-to)2170-2180
Number of pages11
JournalClinical Journal of the American Society of Nephrology
Volume10
Issue number12
DOIs
StatePublished - Dec 7 2015

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Renal Dialysis
Hospitalization
Infection
Dialysis
Medicare
Social Class
Information Systems
Serum Albumin
Chronic Obstructive Pulmonary Disease
Chronic Kidney Failure
Fistula
Substance-Related Disorders
Nurses
Confidence Intervals
Kidney

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Risk factors for infection-related hospitalization in in-center hemodialysis. / Dalrymple, Lorien; Mu, Yi; Nguyen, Danh V.; Romano, Patrick S; Chertow, Glenn M.; Grimes, Barbara; Kaysen, George; Johansen, Kirsten L.

In: Clinical Journal of the American Society of Nephrology, Vol. 10, No. 12, 07.12.2015, p. 2170-2180.

Research output: Contribution to journalArticle

Dalrymple, Lorien ; Mu, Yi ; Nguyen, Danh V. ; Romano, Patrick S ; Chertow, Glenn M. ; Grimes, Barbara ; Kaysen, George ; Johansen, Kirsten L. / Risk factors for infection-related hospitalization in in-center hemodialysis. In: Clinical Journal of the American Society of Nephrology. 2015 ; Vol. 10, No. 12. pp. 2170-2180.
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abstract = "Background and objectives Infection-related hospitalizations have increased dramatically over the last 10 years in patients receiving in-center hemodialysis. Patient and dialysis facility characteristics associated with the rate of infection-related hospitalization were examined, with consideration of the region of care, rural-urban residence, and socioeconomic status. Design, setting, participants, & measurements The US Renal Data System linked to the American Community Survey and Rural-Urban Commuting Area codes was used to examine factors associated with hospitalization for infection among Medicare beneficiaries starting in-center hemodialysis between 2005 and 2008. A Poisson mixed effects model was used to examine the associations among patient and dialysis facility characteristics and the rate of infection-related hospitalization. Results Among 135,545 Medicare beneficiaries, 38,475 (28{\%}) had at least one infection-related hospitalization. The overall rate of infection-related hospitalization was 40.2 per 100 person-years. Age ≥85 years old, cancer, chronic obstructive pulmonary disease, inability to ambulate or transfer, drug dependence, residence in a care facility, serum albumin < 3.5 g/dl at dialysis initiation, and dialysis initiation with an access other than a fistula were associated with a ≥20{\%} increase in the rate of infection-related hospitalization. Patients residing in isolated small rural compared with urban areas had lower rates of hospitalization for infection (rate ratio, 0.91; 95{\%} confidence interval, 0.86 to 0.97), and rates of hospitalization for infection varied across the ESRD networks. Measures of socioeconomic status (at the zip code level), total facility staffing, and the composition of staff (percentage of nurses) were not associated with the rate of hospitalization for infection. Conclusions Patient and facility factors associated with higher rates of infection-related hospitalization were identified. The findings from this study can be used to identify patients at higher risk for infection and inform the design of infection prevention strategies.",
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