Race/ethnicity, age, and risk of hospital admission and length of stay during the first year of maintenance hemodialysis.

BACKGROUND AND OBJECTIVES Although patients undergoing maintenance hemodialysis have exceptionally high hospitalization rates, the risk factors for hospitalizations are unclear. This study sought to examine hospitalization rates among hemodialysis patients in the United States according to both race/ethnicity and age. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS US Renal Data System data on 563,281 patients beginning maintenance hemodialysis between 1995 and 2009 were analyzed. Rates of hospital admission and number of hospital days for all-cause and cause-specific hospitalizations during the first year of dialysis were compared among blacks, whites, and Hispanics in the entire cohort and subgroups stratified by age. RESULTS After multiple adjustments, compared with whites, Hispanics overall had lower rates of both all-cause hospital days (adjusted rate ratio [aRR], 0.91; 95% confidence interval [95% CI], 0.90 to 0.93; P<0.001) and hospital admissions (aRR, 0.89; 95% CI, 0.88 to 0.90; P<0.001), whereas blacks had a lower rate of all-cause admissions (aRR, 0.95; 95% CI, 0.94 to 0.96; P<0.001). The racial/ethnic differences, however, varied by age. Hispanics exhibited the lowest rates of hospital days and admissions for all age groups≤70 years, but those >80 years had higher rates than their white counterparts. The adjusted black-to-white rate ratios exhibited a U-shaped pattern with age, with higher rates for blacks in the younger and older age groups. Hospitalization rates for dialysis-related infections were markedly higher in blacks and Hispanics than whites, which were consistent in all age groups for blacks (aRRs for hospital days ranged from 1.09 to 1.36) and all ages>60 years for Hispanics (aRRs ranged from 1.20 to 1.38). CONCLUSIONS There are significant racial/ethnic differences in hospitalization rates within first year of dialysis, which are not consistent across the age groups and also differ by causes of hospitalization. Overall, blacks and Hispanics had lower rates of all-cause hospital admissions than whites. However, younger and older blacks and older Hispanics were at greatest risk.

[1]  W. Winkelmayer,et al.  Hispanic ethnicity and vascular access use in patients initiating hemodialysis in the United States. , 2012, Clinical journal of the American Society of Nephrology : CJASN.

[2]  M. Fine,et al.  Associations of race and ethnicity with anemia management among patients initiating renal replacement therapy. , 2007, Journal of the National Medical Association.

[3]  L. Agodoa,et al.  Hospitalizations for Valvular Heart Disease in Chronic Dialysis Patients in the United States , 2002, Nephron.

[4]  J. Avorn,et al.  Delayed nephrologist referral and inadequate vascular access in patients with advanced chronic kidney failure. , 2002, Journal of clinical epidemiology.

[5]  K. Servilla,et al.  Hospital admissions in elderly patients on chronic hemodialysis , 2011, International Urology and Nephrology.

[6]  Connie M. Rhee,et al.  Impact of Age, Race and Ethnicity on Dialysis Patient Survival and Kidney Transplantation Disparities , 2014, American Journal of Nephrology.

[7]  R. Foley,et al.  The state of chronic kidney disease, ESRD, and morbidity and mortality in the first year of dialysis. , 2009, Clinical journal of the American Society of Nephrology : CJASN.

[8]  Shu-cheng Chen,et al.  Prevalence of arteriovenous fistulas in incident hemodialysis patients: correlation with patient factors that may be associated with maturation failure. , 2012, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[9]  Hui Xue,et al.  Hemodialysis access usage patterns in the incident dialysis year and associated catheter-related complications. , 2013, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[10]  A. Sehgal Outcomes of renal replacement therapy among blacks and women. , 2000, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[11]  Keith C. Norris,et al.  Race, gender, and socioeconomic disparities in CKD in the United States. , 2008, Journal of the American Society of Nephrology : JASN.

[12]  R. Hakim,et al.  The association of race with erythropoietin dose in patients on long-term hemodialysis. , 2008, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[13]  R. Hays,et al.  Racial differences in health-related quality of life among hemodialysis patients. , 2004, Kidney international.

[14]  Keith C. Norris,et al.  Racial and Ethnic Differences in Mortality of Hemodialysis Patients: Role of Dietary and Nutritional Status and Inflammation , 2011, American Journal of Nephrology.

[15]  Keith C. Norris,et al.  The relationship of age, race, and ethnicity with survival in dialysis patients. , 2013, Clinical journal of the American Society of Nephrology : CJASN.

[16]  S. Beddhu,et al.  Impact of dialysis dose and membrane on infection-related hospitalization and death: results of the HEMO Study. , 2003, Journal of the American Society of Nephrology : JASN.

[17]  W. McClellan,et al.  Racial and Gender Differences in Arteriovenous Fistula Use among Incident Hemodialysis Patients , 2010, American Journal of Nephrology.

[18]  E. Friedman,et al.  Delayed referral of black, Hispanic, and older patients with chronic renal failure. , 1999, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[19]  M. Pauly,et al.  Survival analysis of patients undergoing dialysis. , 1987, JAMA.

[20]  G. Eknoyan,et al.  The dialysis outcomes quality initiative: history, impact, and prospects. , 2000, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[21]  P. Eggers,et al.  CARDIOVASCULAR AND SURVIVAL PARADOXES IN DIALYSIS PATIENTS: Racial and Ethnic Disparities in End‐Stage Kidney Failure—Survival Paradoxes in African‐Americans , 2007, Seminars in dialysis.

[22]  M. Rocco,et al.  Racial/ethnic analysis of selected intermediate outcomes for hemodialysis patients: results from the 1997 ESRD Core Indicators Project. , 1999, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[23]  Keith C. Norris,et al.  The associations between race and geographic area and quality-of-care indicators in patients approaching ESRD. , 2013, Clinical journal of the American Society of Nephrology : CJASN.

[24]  Keith C. Norris,et al.  Racial survival paradox of dialysis patients: robust and resilient. , 2012, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[25]  N. Powe,et al.  Timing of nephrologist referral and arteriovenous access use: the CHOICE Study. , 2001, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[26]  M. Rocco,et al.  Risk factors for hospital utilization in chronic dialysis patients. Southeastern Kidney Council (Network 6). , 1996, Journal of the American Society of Nephrology : JASN.

[27]  S. Grambow,et al.  Physician-diagnosed depression as a correlate of hospitalizations in patients receiving long-term hemodialysis. , 2005, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[28]  W. Owen,et al.  Dose of hemodialysis and survival: differences by race and sex. , 1998, JAMA.

[29]  M. Rocco,et al.  Cardiac diseases in maintenance hemodialysis patients: results of the HEMO Study. , 2004, Kidney international.

[30]  L. Kucirka,et al.  Association of race and age with survival among patients undergoing dialysis. , 2011, JAMA.