Hospitalization During Advancing Chronic Kidney Disease

T. Christian H. Mix, Wendy L. St. Peter, Jim Ebben, Jay Xue, Brian J.G. Pereira, Annamaria T. Kausz, Allan J. Collins

Research output: Contribution to journalArticlepeer-review

55 Scopus citations


Backqround: The care of patients with end-stage renal disease (ESRD) is associated with substantial costs to society, much of which is accounted for by a high rate of hospitalization. However, the influence of declining kidney function on hospitalization as ESRD approaches is not well understood. Methods: We performed a retrospective cohort study of national data to evaluate the frequency of hospitalizations among patients with chronic kidney disease (CKD) who reached ESRD and had at least 2 years of Medicare eligibility before initiation of dialysis therapy. The study period for each patient extended from 2 years before to 6 months after the initiation of dialysis therapy. Results: The study cohort was composed of 109,321 patients with a mean age of 75 years, all of whom initiated long-term dialysis therapy between 1995 and 1998. Mean hospitalization rate was 134 hospitalizations/1,000 patient-months at risk (PMAR). Hospitalization rates gradually increased as ESRD approached, peaking in the 3 months immediately after the initiation of dialysis therapy at 487 hospitalizations/1,000 PMAR. Cause-specific hospitalization rates mirrored this trend and were greatest for placement of vascular access and diagnoses related to cardiovascular (CVD) and infectious disease. Conclusion: Hospitalizations during CKD become more frequent with the approach of ESRD. The majority of these hospitalizations, both before and after the initiation of dialysis therapy, are caused by comorbidity related to CKD. These hospitalizations may be favorably impacted on by heightened attention to the prevention and management of CVD and timely placement of vascular access during CKD.

Original languageEnglish (US)
Pages (from-to)972-981
Number of pages10
JournalAmerican Journal of Kidney Diseases
Issue number5
StatePublished - Nov 2003
Externally publishedYes

Bibliographical note

Funding Information:
Supported in part by Amgen, Inc, Thousand Oaks, CA; and grants no. 1F32DK59704–01 (T.-C.H.M.) and 1K08DK02745 (A.T.K.) from The National Institutes of Health. B.J.G.P. serves on Amgen’s Aranesp® Medical Advisory Board.


  • Chronic kidney disease (CKD)
  • End-stage renal disease (ESRD)
  • Health care resources
  • Hospitalization


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