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Survival after acute hemodialysis in Pennsylvania, 2005-2007: A retrospective cohort study

Ramer, SJ and Cohen, ED and Chang, CCH and Unruh, ML and Barnato, AE (2014) Survival after acute hemodialysis in Pennsylvania, 2005-2007: A retrospective cohort study. PLoS ONE, 9 (8).

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Abstract

Background: Little is known about acute hemodialysis in the US. Here we describe predictors of receipt of acute hemodialysis in one state and estimate the marginal impact of acute hemodialysis on survival after accounting for confounding due to illness severity. Materials and Methods: This is a retrospective cohort study of acute-care hospitalizations in Pennsylvania from October 2005 to December 2007 using data from the Pennsylvania Health Care Cost Containment Council. Exposure variable is acute hemodialysis; dependent variable is survival following acute hemodialysis. We used multivariable logistic regression to determine propensity to receive acute hemodialysis and then, for a Cox proportional hazards model, matched acute hemodialysis and non-acute hemodialysis patients 1:5 on this propensity. Results: In 2,131,248 admissions of adults without end-stage renal disease, there were 6,657 instances of acute hemodialysis. In analyses adjusted for predicted probability of death upon admission plus other covariates and stratified on age, being male, black, and insured were independent predictors of receipt of acute hemodialysis. One-year post-admission mortality was 43% for those receiving acute hemodialysis, compared to 13% among those not receiving acute hemodialysis. After matching on propensity to receive acute hemodialysis and adjusting for predicted probability of death upon admission, patients who received acute hemodialysis had a higher risk of death than patients who did not over at least 1 year of follow-up (hazard ratio 1.82, 95% confidence interval 1.68-1.97). Conclusions: In a populous US state, receipt of acute hemodialysis varied by age, sex, race, and insurance status even after adjustment for illness severity. In a comparison of patients with similar propensity to receive acute hemodialysis, those who did receive it were less likely to survive than those who did not. These findings raise questions about reasons for lack of benefit. © 2014 Ramer et al.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Ramer, SJ
Cohen, ED
Chang, CCH
Unruh, ML
Barnato, AE
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
EditorSingh, Shree RamUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Date: 20 August 2014
Date Type: Publication
Journal or Publication Title: PLoS ONE
Volume: 9
Number: 8
DOI or Unique Handle: 10.1371/journal.pone.0105083
Schools and Programs: Graduate School of Public Health > Biostatistics
Graduate School of Public Health > Health Policy & Management
School of Medicine > Clinical and Translational Science
School of Medicine > Medicine
Refereed: Yes
Date Deposited: 26 Sep 2014 14:33
Last Modified: 04 Feb 2019 14:55
URI: http://d-scholarship.pitt.edu/id/eprint/23002

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