ArticleResearch and practice in thrombosis and haemostasis2026
Health care resource utilization and costs of major bleeding in patients with and without dialysis-dependent end-stage kidney disease: a retrospective study.
Article in Research and practice in thrombosis and haemostasis, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Major bleeding is common in dialysis-dependent end-stage kidney disease (ESKD). Objectives: To compare healthcare resource utilization (HCRU) and costs of major bleeding events between dialysis and non-dialysis populations. Methods: We identified fee-for-service Medicare beneficiaries aged ≥66 years with a first (index) major bleeding event in 2015-2018. Patients with ESKD receiving in-center hemodialysis (HD) and home dialysis from the US Renal Data System were each compared to patients without ESKD from a 20% Medicare sample. HCRU and cost outcomes were compared using model-based standardization, adjusted for age, sex, and race, during the index major bleeding event and a 1-year follow-up period. Results: Patients receiving in-center HD had index major bleeding hospitalizations that were longer and costlier (adjusted mean differences: 0.7 days [95% CI, 0.6-0.8] and $3.4K [95% CI, $3.2K-$3.7K]) than those without ESKD. During 1-year follow-up, bleeding-related hospitalizations were more common (adjusted rate difference: 37.6 per 100 person-years [95% CI, 35.2-40.1]) and costly (adjusted per-person per-year cost difference: $6.2K [95% CI, $5.8K-$6.7K]) in patients receiving in-center HD than in those without ESKD. Other than blood transfusions, which were more common in home dialysis than in-center HD (adjusted rates per 100 person-years: 255.8 [95% CI, 241.8-269.8] vs 202.1 [95% CI, 199.2-205.0]), HCRU outcomes were generally similar between the dialysis groups. Conclusion: Patients receiving dialysis had longer and costlier major bleeding hospitalizations and accrued substantially higher costs after 1 year versus those without ESKD. Readmissions were a key driver of higher HCRU and costs in ESKD.
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