Inpatient Dialysis Initiation Higher for Patients With CKD and Heart Failure

FRIDAY, March 7, 2025 (HealthDay News) — Patients with chronic kidney disease (CKD) and heart failure have higher rates of inpatient dialysis initiation than those without heart failure, according to a study published online Feb. 18 in Mayo Clinic Proceedings.

Mitchell E. Flagg, M.D., from Kaiser Permanente Los Angeles Medical Center, and colleagues conducted a cross-sectional study of patients with CKD aged 18 years or older within Kaiser Permanente Southern California who initiated maintenance dialysis between Jan. 1, 2007, and Dec. 31, 2018, to explore dialysis transition patterns, including inpatient initiation.

Thirty-seven percent of the 6,812 patients with CKD initiating dialysis had heart failure. The researchers found that 18.5 percent of patients with and 9.6 percent of patients without heart failure had inpatient initiation of dialysis. The mean estimated glomerular filtration rate at dialysis was 11.3 and 9.4 mL/min/1.73 m² with and without heart failure, respectively. Among 5,499 patients who initiated hemodialysis, central venous catheter (CVC) use occurred in 58.5 and 51.9 percent of the patients with and without heart failure, respectively. Patients with versus those without heart failure had multivariate rate ratios of 1.46 (95 percent confidence interval [CI], 1.26 to 1.69) for inpatient dialysis initiation and 1.04 (95 percent CI, 0.99 to 1.10) for CVC use. The rate ratio for CVC placement was 1.23 (95 percent CI, 1.14 to 1.33) for patients with heart failure with reduced ejection fraction.

“CKD patients with heart failure are more likely to initiate maintenance dialysis in contexts associated with greater resource expenditure and risk of suboptimal outcomes; they had significantly higher rates of inpatient dialysis initiation and of hemodialysis access by CVC,” the authors write.

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