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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2019  |  Volume : 30  |  Issue : 2  |  Page : 508-512
Etiology and frequency of hospital admissions in maintenance hemodialysis patients in chronic kidney disease

Department of Medicine, Chattogram Maa-O-Shishu Hospital Medical College, Chattogram, Bangladesh

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Date of Submission01-Mar-2018
Date of Acceptance07-Apr-2018
Date of Web Publication23-Apr-2019


Chronic kidney disease (CKD) and end-stage renal disease are a global health problem worldwide. In developing countries, it is a particular challenge to deliver optimal hemodialysis (HD) due to prevailing socioeconomic conditions. This has multiple downstream effects, including frequent hospitalizations and increased morbidity. We conducted this retrospective study to identify the etiology of hospital admission in HD patients and to detect the duration and costs associated with their hospitalizations. A total of 42 maintenance HD patients were hospitalized during this time frame and their hospitalizations were studied for the purpose of this study. CKD is growing global public health problem causing socioeconomic impact. Hence, early detection and referral to nephrology services can reduce hospitalization rates after a planned dialysis start thus might improve patients’ quality of life.

How to cite this article:
Nath JD, Kashem A. Etiology and frequency of hospital admissions in maintenance hemodialysis patients in chronic kidney disease. Saudi J Kidney Dis Transpl 2019;30:508-12

How to cite this URL:
Nath JD, Kashem A. Etiology and frequency of hospital admissions in maintenance hemodialysis patients in chronic kidney disease. Saudi J Kidney Dis Transpl [serial online] 2019 [cited 2022 Jun 26];30:508-12. Available from: https://www.sjkdt.org/text.asp?2019/30/2/508/256858

   Introduction Top

Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are now global burden and affect both healthcare resource use and overall costs and contributing huge mortality and morbidity. CKD has become alarming now as one in 10 people worldwide have kidney disease and a wide range of prevalence globally. By region, the estimated prevalence ranges from 7% in South Asia and 8% in Africa to 11% in North America and 12% in Europe. Among high-income countries, Saudi Arabia and Belgium had the highest prevalence rates, at 24% each, followed by Poland (18%), Germany (17%), the United Kingdom (16%), and Singapore (16%).[1],[2]

There is a CKD prevalence of 16–18% in Bangladesh of whom over 10% are CKD stage III and above.[3],[4] Hospitalizations is common for hemodialysis (HD) patients in view of the various comorbidities suffered by HD patients.[5],[6],[7] Infection and cardiovascular diseases are the major causes of death in this group of patients, and the hospitalizations costs are tremendous.

   Materials and Methods Top

The study was a retrospective observational study. The study was conducted in the Department of Medicine, Maa-Shishu-O-General Hospital, Agrabad, Chattogram from April 2017 to December 2017. All prevalent HD patients admitted in during this time frame were included in this study. Patients <6 months on HD were excluded for the purposes of this study as complications due to vascular access are very high during this time frame and only patients over six months on HD were included in this study. After two years of regular dialysis, patients were excluded due to adaptation and less hospital admissions rate. All reasons for admission were reviewed and analyzed. Basic demographic data were recorded and patients were grouped on those who were dialyzing twice or thrice a week.

   Results Top

A total of 42 patients were assessed [Table 1], [Table 2], [Table 3]. About 61.9% (n = 26) of the study population were male. Both hypertension (HTN) and diabetes mellitus (DM) were found in 35.7% (n = 15). Of 42 patients, 83.3% (n =35) was compliant on regular medications and 16.7% (n = 7) was noncompliant to drugs. Most of the patients 33.3% (n = 14) belonged to 41 to 50 years group. Mean hospital admission was 2.8 times per patient during the study period.
Table 1: Distribution of sex.

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Table 2: Distribution of age groups.

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Table 3: Causes of end-stage renal disease.

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   Discussion Top

Concomitant HTN and DM were the major causes of CKD in our study (n = 15). From then n = 5, 33.3% got admitted maximum thrice times, whereas n = 4, 26.7%) admitted for five times after starting dialysis. The next common etiology was solely HTN (n = 10), from them half of the patients (n = 5, 50%) got admitted twice times comparing to third times admission for (n = 2, 40%) diabetic patient only (n = 5).

Infection-related and cardiovascular-related admission rates were also little higher in our study (0.68 and 0.99 per person-year) comparatives to (0.46 and 0.56) a study among patients on HD in 2007 in the US.[8]

Left ventricular failure (LVF) is the most common cause of hospitalization due to uncontrolled HTN, dilated cardiomyopathy, and acute coronary syndromes. About 36.3% of patients (n = 4) developed LVF as their etiology of CKD was only HTN and concomitant HTN and DM. Among infection, urinary tract infection (UTI) is more common (23.5%) and documented in our study probably related to less water intake due to fearing edema. Hypoglycemia is also common 50% in patients with had both HTN and DM.

In one study in Japan showed the most common admitting diagnoses for patients with ESRD were cardiovascular (e.g., congestive heart failure, myocardial infarction, and arrhythmia) in 31%, sepsis in 15%, and cardiac arrest (mechanism not specified) in 10%. That is consistent with our study 34.3% is LVF (causes not specified) and 23.5% is UTI [Figure 1], [Table 4].[9]
Figure 1: Current hospital admission status.

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Table 4: Reasons for hospitalizations.

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Dialysis patients have a greater number of hospitalization events compared to patients without renal failure, as they have a high prevalence of comorbid conditions and treatment-related complications. Mean hospital stay for the first admission was 3.8 ± 1.19 days, 40.5% (n = 17) of patients [Figure 2].
Figure 2: Total length of stay of current admission.

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Ten patients (35.7%) who underwent regular dialysis twice weekly got admitted three times in hospital while maximum six patients (50%) got admission for twice undergoing thrice-weekly dialysis. Patients who did not undergo regular dialysis, (n = 2, 100%), admitted maximum five times [Table 5] and [Table 6].
Table 5: Relationship between frequency of hospital admission and weekly dialysis.

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Table 6: Distribution of frequent hospital admissions.

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Our study shows for reduced hospitalization rates where patients who underwent for HD thrice weekly versus those who underwent HD twice a week. Several studies have identified the long (two-day) interdialytic interval as an independent risk factor for all-cause mortality and cardiovascular hospitalization in patients treated with thrice-weekly HD,[10],[11] which is most likely due to fluid overload and/or electrolyte derangements. The US Renal Data System annual report[8] suggests that admission rates are higher in the 1st year of dialysis. Another study showed that >50% of patients initiating dialysis are admitted to hospital in the first 100 days of dialysis.[12] Twenty-five of 42 patients (83.3%) were concordant with medications while 16.7% (n = 7) was non concordant.

Those who four out of seven who were non concordant were admitted three or more times third times comparative to eight out of 25 in the concordant group. Mean hospitalizations were 2.8 times, and the average duration of stays was 3.8 days in this study group.

   Conclusion Top

CKD is global public health problem causing huge burden for low- and middle-income countries, low resource countries.

Poverty has a negative impact on access to health care, and this is compounded by the lack of health literacy and the other socioeconomic factors. Improving health literacy, both to patient and family members might help to reduce hospitalization cost and improves patients’ quality of life.

Conflict of interest: None declared.

   References Top

Bello AK, Levin A, Tonelli M, et al. Assessment of Global Kidney Health Care Status. JAMA 2017;317:1864-81.  Back to cited text no. 1
Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: Global dimension and perspectives. Lancet 2013;382:260-72.  Back to cited text no. 2
Alam KS, Huda MN, Rashid HU, Saha M. Prevalence of diabetes mellitus, hypertension, proteinuria and association of these risk factors with estimated glomerular filtration rate (eGFR) in adult disadvantaged population. Bangladesh Renal J 2010;29:1-6.  Back to cited text no. 3
Faroque MO, Rashid HU, Rahman MH, Alam MR, Islam S. Prevalence of diabetes mellitus, hypertension and proteinuria in a rural area of Bangladesh. Bangladesh Renal J 2010;29:7-11.  Back to cited text no. 4
Stern A, Sachdeva S, Kapoor R, Singh J, Sachdeva S. High blood pressure in dialysis patients: Cause, pathophysiology, influence on morbidity, mortality and management. J Clin Diagn Res 2014;8(6):ME01-4.  Back to cited text no. 5
Inrig JK. Antihypertensive agents in hemodialysis patients: A current perspective. Semin Dial 2010;23:290-7.  Back to cited text no. 6
Al-Dadah A, Omran J, Nusair MB, Dellsperger KC. Cardiovascular mortality in dialysis patients. Adv Perit Dial 2012;28:56-9.  Back to cited text no. 7
US Renal Data System. USRDS 2011 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda (MD): National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2011.  Back to cited text no. 8
Strijack B, Mojica J, Sood M, et al. Outcomes of chronic dialysis patients admitted to the intensive care unit. J Am Soc Nephrol 2009;20:2441-7.  Back to cited text no. 9
Foley RN, Gilbertson DT, Murray T, Collins AJ. Long interdialytic interval and mortality among patients receiving hemodialysis. N Engl J Med 2011;365:1099-107.  Back to cited text no. 10
Zhang H, Schaubel DE, Kalbfleisch JD, et al. Dialysis outcomes and analysis of practice patterns suggests the dialysis schedule affects day-of-week mortality. Kidney Int 2012;81: 1108-15.  Back to cited text no. 11
Quinn MP, Cardwell CR, Rainey A, et al. Patterns of hospitalisation before and following initiation of haemodialysis: A 5 year single centre study. Postgrad Med J 2011;87: 389-93.  Back to cited text no. 12

Correspondence Address:
Jishu Deb Nath
Department of Medicine, Chattogram Maa-O-Shishu Hospital Medical College, Chattogram
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-2442.256858

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  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]

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