ArticleJournal of the American Society of Nephrology : JASN2014
Healthcare intensity at initiation of chronic dialysis among older adults.
Article in Journal of the American Society of Nephrology : JASN, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 1 of them a synthesis that pooled it.
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Who cites it
38 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The Japanese clinical practice guideline for acute kidney injury 2016.Clinical and experimental nephrology · 2018Guideline
- Cardiorenal Syndrome in the Elderly: Challenges and Considerations.Geriatrics (Basel, Switzerland) · 2025Review
- Hemodialysis Procedures for Stable Incident and Prevalent Patients Optimize Hemodynamic Stability, Dialysis Dose, Electrolytes, and Fluid Balance.Journal of clinical medicine · 2024Review
- Article
- Decision-making about dialysis: Beyond just dialysis or death.Journal of the American Geriatrics Society · 2023Article
- The VA Life-Sustaining Treatment Decisions Initiative: A qualitative analysis of veterans with advanced kidney disease.Journal of the American Geriatrics Society · 2022Article
- Challenges to Shared Decision Making About Treatment of Advanced CKD: A Qualitative Study of Patients and Clinicians.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2022Article
- Frailty Severity and Hospitalization After Dialysis Initiation.Canadian journal of kidney health and disease · 2021Article
- Validation of prognostic indices for short term mortality in an incident dialysis population of older adults >75.PloS one · 2021Article
- Ethical Concerns in the Care of Patients with Advanced Kidney Disease: a National Retrospective Study, 2000-2011.Journal of general internal medicine · 2020Article
- Experiences of US Nephrologists in the Delivery of Conservative Care to Patients With Advanced Kidney Disease: A National Qualitative Study.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2020Article
- Serious Illness Treatment Preferences for Older Adults with Advanced CKD.Journal of the American Society of Nephrology : JASN · 2019Article
- Incremental hemodialysis, a valuable option for the frail elderly patient.Journal of nephrology · 2019Review
- Care Practices for Patients With Advanced Kidney Disease Who Forgo Maintenance Dialysis.JAMA internal medicine · 2019Article
- Savings Opportunity from Improved CKD Care Management.Journal of the American Society of Nephrology : JASN · 2018Article
- End-of-Life Care for Patients With Advanced Kidney Disease in the US Veterans Affairs Health Care System, 2000-2011.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2018Article
- Association Between Hospice Length of Stay, Health Care Utilization, and Medicare Costs at the End of Life Among Patients Who Received Maintenance Hemodialysis.JAMA internal medicine · 2018Observational
- Improving the prognosis of patients with severely decreased glomerular filtration rate (CKD G4+): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.Kidney international · 2018Article
- The Japanese Clinical Practice Guideline for acute kidney injury 2016.Journal of intensive care · 2018Article
- Hospitalizations and Nursing Facility Stays During the Transition from CKD to ESRD on Dialysis: An Observational Study.Journal of general internal medicine · 2017Observational
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3 authors.
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No grant is acknowledged in the PubMed record.
Abstract
Little is known about the circumstances under which older adults initiate chronic dialysis and subsequent outcomes. Using national registry data, we conducted a retrospective analysis of 416,657 Medicare beneficiaries aged ≥67 years who initiated chronic dialysis between January 1995 and December 2008. Our goal was to define the relationship between health care intensity around the time of dialysis initiation and subsequent survival and patterns of hospitalization, use of intensive procedures (mechanical ventilation, feeding tube placement, and cardiopulmonary resuscitation), and discontinuation of dialysis before death. We found that most patients (64.5%) initiated dialysis in the hospital, including 36.6% who were hospitalized for ≥2 weeks and 7.4% who underwent one or more intensive procedures. Compared with patients who initiated dialysis in the outpatient setting, those who received the highest intensity of care at dialysis initiation (those hospitalized ≥2 weeks and receiving at least one intensive procedure) had a shorter median survival (0.7 versus 2.1 years; P<0.001), spent a greater percentage of remaining follow-up time in the hospital (median, 22.9% versus 3.1%; P<0.001), were more likely to undergo subsequent intensive procedures (44.9% versus 26.0%; adjusted hazard ratio, 2.33; 95% confidence interval [CI], 2.27 to 2.39), and were less likely to have discontinued dialysis before death (19.1% versus 26.2%; adjusted odds ratio, 0.68; 95% CI, 0.65 to 0.72). In conclusion, most older adults initiate chronic dialysis in the hospital. Those who have a prolonged hospital stay and receive other forms of life support around the time of dialysis initiation have limited survival and more intensive patterns of subsequent healthcare utilization.
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