Abstract
Introduction: Dialysis patients are often discharged from hospitals to skilled nursing facilities (SNFs), but little has been published about their natural history. Methods: Using electronic medical record data, we conducted a retrospective cohort study of nursing home patients treated with in-SNF hemodialysis from January 1, 2018 through June 20, 2020 within a dialysis organization across eight states. A dialytic episode began with the first in-SNF dialysis and was ended by hospitalization, death, transfer, or cessation of treatment. The clinical characteristics and natural history of these patients and their dialytic episodes are described. Findings: Four thousand five hundred and ten patients experienced 9274 dialytic episodes. Dialytic episodes had a median duration of 18 days (IQR: 8–38) and were terminated by a hospitalization n = 5747 (62%), transfer n = 2638 (28%), death n = 568 (6%), dialysis withdrawal n = 129 (1.4%), recovered function n = 2 (0.02%), or other cause n = 6 (0.06%). Increased patient mortality was associated with advancing age, low serum creatinine, albumin, or sodium, and low pre-dialytic systolic blood pressure (sBP). U-shaped relationships to mortality were observed for intradialytic hypotension frequency and for post- > pre-hemodialysis sBP frequency. Prescription of dialysis five times weekly in the first 2 weeks was associated with better survival in the first 90 days (HR 0.77, CI 0.62–0.96; p < 0.02). Discussion: Provision of in-SNF dialysis by an external dialysis organization enables discharge from the acute care setting for appropriate treatment with increased nursing contact time in an otherwise under-resourced environment. SNF ESRD patient clinical characteristics and outcomes are extensively characterized for the first time.
Original language | English (US) |
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Pages (from-to) | 548-559 |
Number of pages | 12 |
Journal | Hemodialysis International |
Volume | 25 |
Issue number | 4 |
DOIs | |
State | Published - Oct 2021 |
Keywords
- ESRD
- epidemiology
- hemodialysis
- intradialytic hypotension
- mortality risk factors
- nursing home
ASJC Scopus subject areas
- Hematology
- Nephrology