HOSPITALIZATIONS AMONG HEMODIALYSIS PATIENTS IN A LARGE TERTIARY CARE CENTRE: LESSONS ABOUT THE MORBIDITY OF HEMODIALYSIS PATIENTS IN INDIA

Introduction:

Hospitalization among patients on hemodialysis has a significant impact on health status and survival. Reasons for hospitalization are due to dialysis access-related complications, volume factors and comorbidity. It adds cost burden and also increases the risk of infection. With a lacuna of knowledge regarding the same in India, we aimed to study the hospitalization rate, reasons and patient characteristics among maintenance hemodialysis patients in a large tertiary care centre.

Methods:

This is a descriptive cross-sectional study. All patients who underwent hemodialysis in a large dialysis unit located in a tertiary care centre in India were followed up from March 1 2024 to June 30, 2024. Demographics, dialysis characteristics and access to hemodialysis facilities were analyzed and presented in proportion. Hospitalization rate in person-years and reasons for hospitalization captured. Data is presented as proportion and mean + standard deviation.

Results:

Among 905 patients registered during the study period, the age range was 19 to 80 years with a mean of 53.47 ± SD 13.9. 99% were under public insurance. 75% were male.  20% had a body mass index of < 18.5, 29%, 18.5 -22.9, 10%, 23 – 24.9 and 20%, > 25. 23% were hypertensive,13% were diabetic, 2% had a history of heart attack and 1% had a history of stroke. 48% had AVF/AVG as their vascular access and 42% were on catheter. The mean haemoglobin level was 9.29 ± SD 2.01, mean creatinine level was 6.09 ± 3.65. Viral serology: 4% were HCV positive, 3%, were HBV positive and 2%, were HIV positive. Regarding traveling distance to the hospital, 39% traveled < 10km, 16%: 10 to 30 km, 17%: 31 to 60 km and 30%: > 60km. The mean vintage period of hemodialysis was 1.72 years. 517 hospitalizations occurred among 373 patients at a rate of 1.8 cases per person - year. Among 373 patients hospitalized, 33% belonged to 61 - 80 years of age, 46%: 41- 60 years and 21%: 18 - 40 years. 72% were male. Dialysis frequency was: < twice-weekly - 56%, twice weekly - 19%, thrice weekly- 23%, > thrice weekly - 3%. 53% were on catheter and 35% on AVF/AVG. The reason for hospitalization is listed as follows: 32.30% for fluid overload, 13.93% for permanent access complication, 5.42% for permanent access creation, 4.84% for temporary access infection, 2.13% for cardiac complications, 0.77% for surgery, 0.58 % for temporary access creation and 0.19 % for stroke (figure 1).

Conclusions:

The hospitalization rate in our population is similar to previously described in large hemodialysis cohorts. Vascular access creation and complications, fluid overload, and cardiac causes were the dominant reasons. Patients who were hospitalized are commonly dialyzed through a catheter, with a low frequency of hemodialysis.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.