Hospitalization among prevalent hemo dialysis patients: one year retrospective study

Background: Incidence of hemodialysis as renal replacement therapy has been increasing continuously in the last decades in Egypt. The risk of hospitalization increases among hemodialysis patients due to factors related to hemodialysis, vascular access or comorbid conditions. Objectives: To measure the frequency and identify the causes of hospital admission among chronic hemodialysis patients and identify factors affecting duration of their hospital stay. Patients and methods: The study population consisted of End Stage Renal Disease (ESRD) patients on regular hemodialysis for more than six months. Total number of patients was 792 recruited from nine different hemodialysis centers in Egypt. A descriptive study was carried out using hospital records for the year 2012. Data extraction sheet was designed to collect data from records as personal data, medical history and laboratory results. Results: Three hundreds and eighty eight patients (49%) had history of hospital admission at least once during the study period. The most frequent cause of hospital admission was complicated A-V fistula in 128 (33%) of the patients followed by disturbed conscious level in 82 (21.1%). No significant difference was found between admitted and non-admitted groups except for type of dialysate used (P value <0.01), vascular access (P value <0.01), presence of hypertension (P value <0.05), presence of ischemic heart disease (P value <0.01), age of patients (P value <0.05) and mean Ca level (P value <0.05). Logistic regression analysis for determinants of hospital admission showed that decreased mean Ca level, using Catheter as a vascular access, using acetate as dialysate , presence of hypertension and presence of ischemic heart disease were significant predictors of hospital admission among hemodialysis patients. The median duration of hospital stay was 7 days with (2-7 IQR), 35 (9.02%) of hospitalized patients had a duration of hospital stay of more than 7 days and no statistically significant difference was found between them and the other hospitalized patients regarding studied parameters except for surface area of dialyzer (P value<0.05). Conclusion: High rate of hospitalization among Egyptian patients on regular hemodialysis especially with complicated AVF as the main cause of admission that increases patient morbidity and financial burden on health care services , needs an integrated vascular management in hemodialysis centers and further studies to determine a comprehensive evidence-based management policy for hemodialysis patients in Egypt .