Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: In older adults, hospitalization often leads to increased frailty, 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 analyzed 2,765 patients who visited hemodialysis clinics at 17 teaching hospitals. The study examined the association between mortality and various factors, including demographics, comorbidities, laboratory findings, and medication use. Hazard ratios (HR) were calculated using survival analysis to determine whether prior hospitalization increased mortality risk in dialysis patients. RESULTS: Of the subjects, 8.0% (n = 222) had been hospitalized for 1 month or longer within the year before starting dialysis. There was no significant difference in gender between the two groups; however, 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. In multivariate analysis, 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). CONCLUSIONS: Patients hospitalized for more than 1 month before starting dialysis had significantly higher overall mortality rates. These findings highlight the need for comprehensive care and targeted interventions for this high-risk population. CLINICAL TRIAL NUMBER: Not applicable.
Source: BMC Geriatrics
Institutions: Hallym University Chuncheon Sacred Heart Hospital, Gyeongsang National University, Gyeongsang National University Hospital, Kangbuk Samsung Hospital, Sungkyunkwan University, The Catholic University of Korea Yeouido St. Mary's Hospital, Catholic University of Korea, Soonchunhyang University, Soonchunhyang University Hospital Seoul, Kyungpook National University Hospital, Kyungpook National University, University of Ulsan, Ulsan University Hospital, Keimyung University Dongsan Hospital, Keimyung University, Presbyterian Medical Center, Soonchunhyang University Hospital Bucheon, Korea University Guro Hospital, Yonsei University, Yonsei University Mirae Campus, Konyang University, Konyang University Hospital, Pusan National University Hospital, Pusan National University, Dongguk University Ilsan Hospital, The Catholic University of Korea Daejeon St. Mary's Hospital, Hallym University
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,190
Award: G428581696
OpenAlex ID: W4415613404