Morbidity and cost implications of inadequate hemodialysis

American hemodialysis patients have short lifespans, frequent hospitalizati ons, and aggregate Medicare inpatient expenditures of $4 billion/year, Dose of dialysis, as quantified by the parameter, Kt/V, corresponds strongly wi th survival and is estimated to be inadequate (Kt/V <1.2) in one fourth of patients. However, little is known about the morbidity and cost implication s of inadequate dialysis. We sought to determine the independent relationsh ip between dose of dialysis and (1) number of hospitalizations, (2) hospita l days, and (3) Medicare inpatient reimbursements, We randomly selected 674 patients from all 22 hemodialysis units in northeast Ohio and examined hos pitalizations, hospital days, and Medicare inpatient reimbursements for a 6 -month interval following a 90-day quantification of dialysis dose. Every 0 .1 decrease in KW was independently associated with more hospitalizations ( rate ratio, 1.11; 95% confidence interval [CI], 1.07 to 1.15), increased ho spital days (rate ratio, 1.12; 95% CI, 1.03 to 1,22), and higher Medicare i npatient expenditures ($940; 95% CI, $450 to $1,440) after adjustment for p atient age, sex, race, cause of renal failure, number of years on dialysis, and number of comorbid conditions, We estimate that increasing dialysis do ses to a Kt/V of 1.2 for all patients nationally may decrease Medicare inpa tient expenditures by $150 million annually. In conclusion, inadequate dial ysis dose is independently associated with increased hospitalizations, hosp ital days, and Medicare inpatient expenditures. Improving dialysis adequacy may both improve patient morbidity and lessen health care costs. (C) 2001 by the National Kidney Foundation, Inc.