From the Guidelines
Hemodialysis significantly increases the likelihood of needing hospitalization, primarily due to complications related to vascular access and infections. Patients undergoing hemodialysis are at a higher risk of hospitalization compared to the general population, with a significant portion of these hospitalizations resulting from vascular access complications, as highlighted in the study by 1. According to 1, infections remain a leading cause of death and hospitalization in dialysis patients, second only to cardiovascular disease. The risk of infection is further increased in outpatient dialysis facilities, emphasizing the need for strict adherence to infection control measures.
Some key factors contributing to the increased likelihood of hospitalization among hemodialysis patients include:
- Vascular access complications, such as thrombosis and stenosis, which can lead to access failure and the need for interventions 1
- Infections, including access site infections and transmission of viral pathogens like hepatitis B and C, and human immunodeficiency virus 1
- Cardiovascular events triggered by the physical stress of the dialysis procedure and fluctuations in fluid levels, blood pressure, and electrolytes
- Bleeding complications from anticoagulants used during treatment
- Complications from underlying conditions like diabetes or hypertension
The study by 1 emphasizes the importance of implementing effective infection control programs in dialysis facilities to reduce infection rates and improve patient safety. Similarly, the guidelines outlined in 1 recommend instituting monitoring programs to detect vascular accesses at risk, establishing quality assurance programs, and developing methods to extend access use-life. By prioritizing these measures, healthcare providers can mitigate some of the risks associated with hemodialysis and reduce the likelihood of hospitalization for these patients.
From the Research
Hemodialysis and Hospitalization
- Hemodialysis can increase the likelihood of needing hospitalization due to various complications, including vascular access complications, infection, and cardiovascular events 2, 3.
- Infection-related hospitalization is a significant challenge with short daily hemodialysis, and poor infection control practices in the home setting can catalyze excess risk 2.
- Observational studies indicate that patients on peritoneal dialysis have a higher risk of hospitalization and longer length of stay compared to those on hemodialysis 3.
- Cardiovascular events and infections are common causes of hospital admission and readmission in patients undergoing hemodialysis and peritoneal dialysis 3, 4, 5.
Risk Factors for Hospitalization
- Vascular access complications, such as access loss and infection, can increase the risk of hospitalization 2, 4.
- Inadequate fluid and electrolyte management can lead to complications, such as hyperkalemia and hypotension, which can require hospitalization 6, 5.
- Patient-related factors, such as poor adherence to treatment and inadequate self-care, can also increase the risk of hospitalization 2, 5.
Prevention of Hospitalization
- Implementing strict aseptic technique and following core interventions for bloodstream infection prevention can reduce the risk of catheter-associated bloodstream infections 4.
- Close monitoring of patients and prompt intervention for complications can help prevent hospitalization 2, 5.
- Patient education and shared decision-making can also play a crucial role in preventing hospitalization by promoting adherence to treatment and self-care 5.