Hospitalization Rates among Patients in Fluid Management Quality Improvement Project

San Diego—The rates of hospitalization and mortality among patients receiving hemodialysis are high compared with the general population; the higher rates are particularly seen in the first 90 days of hemodialysis therapy. Nine dialysis facilities conducted a clinic-wide fluid management quality improvement (QI) project utilizing relative blood volume monitoring (RBV-M).

Paul Balter, MD, and colleagues conducted a retrospective analysis of data from the project to examine hospital admissions among incident hemodialysis patients during the QI project compared with incident patients who did not participate in the project. The researchers reported results of the analysis during a poster session at Kidney Week 2018 in a poster titled Lower Rates of Hospital Admissions During a Fluid Management Quality Improvement (QI) Project Utilizing Relative Blood Volume Monitoring (RBV-M)—A Retrospective Analysis.

The analysis included data on 1068 adult incident hemodialysis patients in the first 90 days of therapy. The data were stratified into three periods: prior to the start of the QI project (pre-QI), during the QI project (QI), and after the end of the QI (post-QI). RBV-M was conducted using Crit-Line® monitors. Hazard ratios (HR) were modeled using all hospital admissions during the first 90 days of hemodialysis therapy. Hospital days across the three periods were compared using Poisson regression.

Of the total cohort, the analysis included 501 patients in the pre-QI time period, 191 in the QI time period, and 376 in the post-QI time period who initiated hemodialysis between 2009 and 2017. There was a difference in the rates of hospital admissions among the three periods (P=.02). Compared with the QI period, the pre-QI period had a 20% increased rate of hospitalization (HR, 1.2; 95% confidence interval [CI], 0.99-1.47); the post-QI period had a 40% increased rate (HR, 1.4; 95% CI, 1.11-1.84).

For the QI period, fewer hospital days were observed (P=.04) compared with the two non-QI groups, with 5.84 (P=.01) fewer hospital days per person-year than the pre-QI group (P=.01) and 4.7 fewer hospital days per person-year than the post-QI group (P=.12).

In summary, the researchers said, “The use of RBV-M as part of a QI on fluid management was associated with a decreased rate of hospital admissions and fewer hospital days among incident hemodialysis patients during the first 90 days of dialysis.”

Source: Balter P, Rao PS, Li Y, Mullon C, Kossmann RJ, Ficociello L. Lower rates of hospital admissions during a fluid management quality improvement (QI) project utilizing relative blood volume monitoring (RBV-M)—A retrospective database analysis. Abstract of a poster (FR-PO788) presented at the American Society of Nephrology Kidney Week 2018, October 26, 2018, San Diego, California.

This analysis was funded by Fresenius Medical Care Renal Therapies Group.