Effects of Hospitalization Before Hemodialysis on Mortality in Patients on Dialysis

Background: Hospitalization leads to increased frailty in the elderly, which can result in higher rates of subsequent hospitalization and mortality. This study investigated whether a history of hospitalization before initiating dialysis affected mortality rates in dialysis patients. Methods: We studied 2,765 dialysis patients to assess whether prior hospitalization raised mortality risk, analyzing demographics, comorbidities, labs, and medications using survival analysis to calculate hazard ratios. Results: 8.0% (n=222) had been hospitalized for 1 month or longer within the year before starting dialysis. The hospitalized group was older, and many patients in this group began dialysis using a catheter. This group also had a higher prevalence of conditions such as cerebrovascular accidents (CVA), hypertension, dementia, heart failure, and atrial fibrillation. Laboratory findings revealed higher platelet counts and blood urea nitrogen (BUN) levels, but lower levels of intact parathyroid hormone, creatinine, albumin, alkaline phosphatase, and cholesterol. Additionally, this group used fewer medications, including renin-angiotensin-aldosterone system blockers, calcium channel blockers, and antiplatelet agents. Controlling for factors such as age, sex, dialysis access, comorbidities (e.g., dementia, malignancy, ischemic heart disease, CVA, heart failure, atrial fibrillation, liver cirrhosis, fractures), ejection fraction, and laboratory markers (e.g., lymphocytes, platelets, BUN, creatinine, albumin, phosphorus, total cholesterol), the HR for mortality in the group with a history of hospitalization was 1.686 (95% CI, 1.162-2.447). Conclusion: Patients hospitalized for more than 1 month before starting dialysis had higher overall mortality rates. These findings highlight the need for comprehensive care and targeted interventions for this high-risk population. Funding: Government Support – Non-U.S.