Prevalence of hospitalization and prognosis of patients on chronic dialysis

Abstract

Background. The process and mechanisms responsible for the poor survival rate of chronic dialysis patients is not well known, and the prevalence of hospitalization and its prognostic significance in these patients has not been well documented.

Methods. We reviewed the database and the clinical records of 2049 patients (1147 men and 902 women) who were on the registries of chronic dialysis programs in Okinawa, Japan. They were prevalent patients on January 1, 1997, and were followed-up for 1 year.

Results. Of the 2049 patients, 13% (n = 259; 118 men, 141 women) were hospitalized, with the leading causes of hospitalization being social causes, vascular, infection, and cardiac problems. Among this group of patients, 25% (n = 66; 33 men, 33 women) died during the 12 months of follow-up. In contrast, among those patients not hospitalized, 3% (n = 58; 36 men, 22 women) died. The 1-year survival rate, calculated by the Kaplan-Meier method, was 96% in the nonhospitalized patients; however, it was 75% in those who were hospitalized (P < 0.001). Cox proportional hazard analysis on the risk of death was performed to determine the significance of hospitalization with adjustment for other clinical variables. The adjusted hazard ratio (95% confidence interval) of the presence of hospitalization was 5.48 (3.74–8.01) compared with the absence of hospitalization (P < 0.0001).

Conclusions. The prognosis of chronic hemodialysis patients who were hospitalized was poor. Adequate social support, control of hypertension, and improvement of nutritional status may be important factors that decrease the need for hospitalization.