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Transplantation. 2017 Dec;101(12):2913-2923. doi: 10.1097/TP.0000000000001839.

Hospitalization Among Individuals Waitlisted For Kidney Transplant.

Author information

1
Department of Epidemiology, Rollins School of Public Health, Atlanta, GA.
2
Medial Scientist Training Program, Emory University School of Medicine, Atlanta, GA.
3
Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
4
Emory Transplant Center, Atlanta, GA.
5
Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA.

Abstract

BACKGROUND:

For patients waitlisted for a deceased-donor kidney, hospitalization is associated with a lower likelihood of transplantation and worse posttransplant outcomes. However, individual-, neighborhood-, and regional-level risk factors for hospitalization throughout the waitlist period and specific causes of hospitalization in this population are unknown.

METHODS:

We used United States Renal Data System Medicare-linked data on patients waitlisted between 2005 and 2013 with continuous enrollment in Medicare parts A and B (n = 53 810) to examine the association between annual hospitalization rate and a variety of demographic, clinical, and social factors. We used multilevel multivariable ordinal logistic regression to estimate odds ratios.

RESULTS:

Factors associated with significantly increased hospitalization rates among waitlisted individuals included older age, female sex, more years on dialysis before waitlisting, tobacco use, panel-reactive antibody greater than 0, public insurance or no insurance at end-stage renal disease diagnosis, more regional acute care hospital beds, and urban residence (all P < 0.05). Among patients dialysis-dependent when waitlisted, individuals with arteriovenous fistulas were significantly less likely than individuals with indwelling catheters or grafts to be hospitalized (odds ratios, 0.79 and 0.82, respectively, both P < 0.001). The most common causes of hospitalization were complications related to devices, implants, and grafts; hypertension; and sepsis.

CONCLUSIONS:

Individual- and regional-level variables were significantly associated with hospitalization while waitlisted, suggesting that personal, health system, and geographic factors may impact patients' risk. Conditions related to dialysis access and comorbidities were common hospitalization causes, underscoring the importance proper access management and care for additional chronic health conditions.

PMID:
28590946
PMCID:
PMC5709154
DOI:
10.1097/TP.0000000000001839
[Indexed for MEDLINE]
Free PMC Article

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