Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Kyoto University Graduate School of Medicine, Human Health Sciences, Kyoto, Japan.
Nephron. 2018;140(3):194-202. doi: 10.1159/000492083. Epub 2018 Aug 28.
BACKGROUND/AIMS: Hemodialysis patients are at high risk of hospitalization and their condition may worsen with repeated hospitalization. The aim of this study was to evaluate the impact of the cumulative number of hospitalizations on post-discharge mortality.
This study was a prospective cohort study. We examined 3,359 adult patients on hemodialysis for at least 90 days who participated in the Japanese Dialysis Outcomes and Practice Patterns Study phases 3 and 4 (2005-2012). The patients hospitalized within 3 months before enrollment were excluded. The main exposure was the time-varying cumulative number of hospitalizations during the follow-up period. Hazard ratios (HRs) for all-cause mortality rate after discharge were estimated by time-dependent Cox regressions after adjusting for potential confounders.
The median follow-up time was 2.7 years, and 873 (26%) patients experienced at least 1 hospitalization during follow-up. The hospitalization rate was 0.23 per person-year and the mortality rate was 0.036 per person-year. The HR and 95% CI for post-discharge mortality increased as the cumulative number of hospitalizations increased: once, 1.41 (0.99-2.00); and twice or more, 2.27 (1.59-3.23). The cause-specific hospitalization categories, "infectious disease" and "cancer," affected post-discharge mortality HRs in a similar manner: 2.41(1.32-4.41) and 2.70 (1.23-5.93), respectively.
A higher cumulative number of hospitalizations is associated with increased post-discharge mortality in chronic hemodialysis patients. The cause-specific hospitalizations category of "infectious disease" showed an impact on mortality similar to that of hospitalization for "cancer." Therefore, physicians should pay more attention to reducing preventable hospitalizations.
背景/目的：血液透析患者住院风险较高，且随着住院次数的增加，病情可能会恶化。本研究旨在评估住院次数的累积量对出院后死亡率的影响。
本研究为前瞻性队列研究。我们纳入了参加日本透析结局和实践模式研究第 3 期和第 4 期（2005-2012 年）的至少接受 90 天血液透析的 3359 例成年患者。排除了在入组前 3 个月内住院的患者。主要暴露因素为随访期间时间依赖性的累积住院次数。在调整了潜在混杂因素后，通过时间依赖性 Cox 回归估计了出院后全因死亡率的风险比（HR）。
中位随访时间为 2.7 年，873 例（26%）患者在随访期间至少住院 1 次。住院率为 0.23 人年，死亡率为 0.036 人年。随着累积住院次数的增加，出院后死亡率的 HR 及 95%CI 呈上升趋势：1 次，1.41（0.99-2.00）；2 次或以上，2.27（1.59-3.23）。特定病因的住院类别，“传染病”和“癌症”，对出院后死亡率的 HR 有类似的影响：2.41（1.32-4.41）和 2.70（1.23-5.93）。
较高的累积住院次数与慢性血液透析患者出院后死亡率的增加相关。“传染病”的特定病因住院类别对死亡率的影响与“癌症”的住院相似。因此，医生应更加注意减少可预防的住院。
