Journal of General Internal Medicine

, Volume 32, Issue 11, pp 1220–1227 | Cite as

Hospitalizations and Nursing Facility Stays During the Transition from CKD to ESRD on Dialysis: An Observational Study

  • Maria E. Montez-Rath
  • Yuanchao Zheng
  • Manjula Kurella Tamura
  • Vanessa Grubbs
  • Wolfgang C. Winkelmayer
  • Tara I. Chang
Original Research



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.


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.


Observational study of patients in the US Renal Data System initiating dialysis from October 2011 to October 2012.


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.


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.


dialysis kidney failure hospitalization nursing facility 




Compliance with Ethical Standards


This work was conducted under a data use agreement between Dr. Chang and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). An NIDDK officer reviewed this manuscript for research compliance and approved of its submission for publication. Data reported herein were supplied by the USRDS. Interpretation and reporting of these data are the responsibility of the authors and should in no way be seen as official policy or interpretation of the US government.


Dr. Chang is supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK; 5K23DK095914). Dr. Montez-Rath and Dr. Kurella Tamura are supported by grant U01DK102150 from the NIDDK.

Prior Presentations

A portion of this work was presented at the American Society of Nephrology Kidney Week 2016, Chicago, IL.

Conflict of Interest

MMR, YZ, and VG report no conflicts of interest.

MKT reports receiving honoraria from US Renal Care.

WCW has received consulting fees from AMAG, Akebia, Amgen, AstraZeneca, Bayer, Daichii Sankyo, Fibrogen, Medtronic, Relypsa, and Vifor FMC Renal Pharma.

TIC has received consulting fees from Janssen Research and Development, LLC.

Supplementary material

11606_2017_4151_MOESM1_ESM.docx (66 kb)
ESM 1 (DOCX 65.7 kb)


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Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Maria E. Montez-Rath
    • 1
  • Yuanchao Zheng
    • 1
  • Manjula Kurella Tamura
    • 1
    • 2
  • Vanessa Grubbs
    • 3
  • Wolfgang C. Winkelmayer
    • 4
  • Tara I. Chang
    • 1
  1. 1.Division of NephrologyStanford University School of MedicineStanfordUSA
  2. 2.VA Palo Alto Health Care SystemGeriatric Research, Education and Clinical Center, Veterans Affairs Palo AltoPalo AltoUSA
  3. 3.Division of NephrologyUniversity of California, San FranciscoSan FranciscoUSA
  4. 4.Selzman Institute for Kidney Health, Section of NephrologyBaylor College of MedicineHoustonUSA

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