CORRELATES OF VASCULAR ACCESS AND NONVASCULAR ACCESS-RELATED HOSPITALIZATIONS IN HEMODIALYSIS-PATIENTS

Four hundred and thirty randomly selected hemodialysis patients, aged 20 years and over, were studied to identifiy risk factors for vascular access and nonvascular access-related hospitalizations in the immedia tely preceding 1 year. Risk estimates for hospitalization were assesse d using a multinominal logistic analysis model. We measured functional status, utilizing a 14-point Karnofsky scale, and in a separate analy sis of covariance, in which Karnofsky score was the outcome, we examin ed the relationships of age, gender, ethnicity, renal diagnosis, and h ospitalization. Individual comparisons were adjusted for multiple comp arison bias by Tukey's Honest Difference method. There were a total of 508 hospitalizations of which 322 (63%) lasted greater than or equal to 1 week. Two hundred and sixty (60%) patients were hospitalized at l east once; 105 (24.4%) for access problems only, 115 (27%) for a nonac cess problem only, and 40 for access and nonaccess-related problems. A ccess-related problems, accounted for 48% of all hospitalizations. The risk of hemodialysis vascular access morbidity was increased in women (p < 0.028) and white (p < 0.048) hemodialysis patients. Neither diab etic nor elderly hemodialysis patients were at greater risk for access hospitalization than their respective counterparts, thought a greater proportion of the access hospitalizations in the elderly (greater tha n or equal to 64 years) lasted greater than or equal to 1 week (p < 0. 0006). More access-related hospitalizations in blacks (64.5%), lasted for greater than or equal to 1 week than in whites (40.6%) (p < 0.001) . Hispanics (p < 0.043), whites (p < 0.002), and the older patients (p < 0.054) were at greater risk for nonaccess hospitalization than blac ks and younger patients, respectively. Even after adjusting for age, r ace, and diabetes, each decrease of one unit in the modified Karnofsky score was associated with a 3-4% increased risk for all types of hosp italization (p < 0.001)-poor functional status is associated with incr eased risk for all hospitalizations. We conclude that the risk for hem odialysis vascular access morbidity is increased in women and white he modialysis patients. Poor functional status is associated with increas ed risk for all hospitalizations.