Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN 55404, USA.
Clin J Am Soc Nephrol. 2010 Jun;5(6):1054-63. doi: 10.2215/CJN.00340110. Epub 2010 Apr 29.
Fluid overload in hemodialysis patients sometimes requires emergent dialysis, but the magnitude of this care has not been characterized. This study aimed to estimate the magnitude of fluid overload treatment episodes for the Medicare hemodialysis population in hospital settings, including emergency departments.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Point-prevalent hemodialysis patients were identified from the Centers for Medicare and Medicaid Renal Management Information System and Standard Analytical Files. Fluid overload treatment episodes were defined by claims for care in inpatient, hospital observation, or emergency department settings with primary discharge diagnoses of fluid overload, heart failure, or pulmonary edema, and dialysis performed on the day of or after admission. Exclusion criteria included stays >5 days. Cost was defined as total Medicare allowable costs for identified episodes. Associations between patient characteristics and episode occurrence and cost were analyzed.
For 25,291 patients (14.3%), 41,699 care episodes occurred over a mean follow-up time of 2 years: 86% inpatient, 9% emergency department, and 5% hospital observation. Heart failure was the primary diagnosis in 83% of episodes, fluid overload in 11%, and pulmonary edema in 6%. Characteristics associated with more frequent events included age <45 years, female sex, African-American race, causes of ESRD other than diabetes, dialysis duration of 1 to 3 years, fewer dialysis sessions per week at baseline, hospitalizations during baseline, and most comorbid conditions. Average cost was $6,372 per episode; total costs were approximately $266 million.
Among U.S. hemodialysis patients, fluid overload treatment is common and expensive. Further study is necessary to identify prevention opportunities.
血液透析患者有时会出现液体超负荷，需要紧急透析，但这种情况的严重程度尚未确定。本研究旨在评估医疗保险血液透析患者在医院环境中（包括急诊科）液体超负荷治疗的严重程度。
设计、设置、参与者和测量方法：从医疗保险和医疗补助肾脏病管理信息系统和标准分析文件中确定了时点流行的血液透析患者。液体超负荷治疗发作的定义是在住院、医院观察或急诊病房环境下，因液体超负荷、心力衰竭或肺水肿的主要出院诊断，以及在入院当天或之后进行透析的护理索赔。排除标准包括住院时间超过 5 天。成本定义为确定发作的医疗保险总可赔付成本。分析了患者特征与发作发生和成本之间的关联。
在 25291 名患者（14.3%）中，有 41699 个治疗发作，平均随访时间为 2 年：86%为住院患者，9%为急诊科，5%为医院观察患者。心力衰竭是 83%发作的主要诊断，液体超负荷占 11%，肺水肿占 6%。与更频繁发作相关的特征包括年龄<45 岁、女性、非裔美国人种族、除糖尿病以外的 ESRD 病因、透析时间 1 至 3 年、基线时每周透析次数较少、基线期间住院治疗以及大多数合并症。平均每个发作的费用为 6372 美元；总成本约为 2.66 亿美元。
在美国血液透析患者中，液体超负荷的治疗很常见且费用昂贵。需要进一步研究以确定预防机会。
