Hemodialysis Nonattendance: Patient Characteristics and Outcomes in a Single Renal Center in North West England

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International Pub Date : 2025-03-06 DOI:10.1111/hdi.13227

Rajkumar Chinnadurai, Jessica Dean, Sharmilee Rengarajan, Julie Gorton, Ivona Baricevic-Jones, Philip A. Kalra, Dimitrios Poulikakos

{"title":"Hemodialysis Nonattendance: Patient Characteristics and Outcomes in a Single Renal Center in North West England","authors":"Rajkumar Chinnadurai, Jessica Dean, Sharmilee Rengarajan, Julie Gorton, Ivona Baricevic-Jones, Philip A. Kalra, Dimitrios Poulikakos","doi":"10.1111/hdi.13227","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>Nonattendance for prescribed hemodialysis (HD) sessions is a form of nonadherence that compromises the delivery of life-sustaining HD therapy and is associated with severe morbidity and mortality. In this study, we aimed to assess the characteristics and outcomes of HD nonattenders in a single renal center in the North West of England.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>HD patients followed by the renal team at our unit between December 2020 and September 2022 were included in this study. Dialysis nonattendance data were retrieved from the incident reports (DATIX) between December 2020 and November 2022, excluding dialysis nonattendance due to concurrent hospitalization. The cohort was split into group 1: no dialysis nonattendance; group 2: two or fewer dialysis nonattendances; and group 3: more than two dialysis nonattendances for comparative analysis. All patients were followed up for outcomes including all-cause mortality, transplantation, and hospitalizations until the study endpoint date of 12/31/2023. Predictors of dialysis nonattendance were identified using logistic regression.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Of the 464 patients, dialysis nonattendance was noted in 149 (32%) patients, of which 79 (17%) had two dialysis nonattendance episodes and 70 (15%) had more than two dialysis nonattendance episodes. Over a median follow-up of 35 months, patients in group 3 had a higher hospitalization episode (4 vs. 1 day, <i>p</i> < 0.001) and lower kidney transplantation rates (4.3% vs. 13%, <i>p</i> = 0.038) compared to patients in group 1. In multivariate regression analysis, younger age (OR: 0.97; 95% CI: 0.95–0.98; <i>p</i> = 0.001), history of smoking (OR: 2.01; 95% CI: 1.12–3.62; <i>p</i> = 0.019), alcohol excess history (OR: 3.49; 95% CI: 1.87–6.49; <i>p</i> < 0.001) and history of mental health illness (OR: 3.01; 95% CI: 1.61–5.62; <i>p</i> = 0.001) were significant predictors of dialysis nonattendance.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Skipping HD is a common phenomenon associated with mental health issues and is associated with increased morbidity. Further research is required to understand the psychosocial determinants of nonadherence and effective models of intervention developed to improve outcomes.</p>\n </section>\n </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"29 3","pages":"363-370"},"PeriodicalIF":1.2000,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.13227","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hemodialysis International","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/hdi.13227","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Nonattendance for prescribed hemodialysis (HD) sessions is a form of nonadherence that compromises the delivery of life-sustaining HD therapy and is associated with severe morbidity and mortality. In this study, we aimed to assess the characteristics and outcomes of HD nonattenders in a single renal center in the North West of England.

Methods

HD patients followed by the renal team at our unit between December 2020 and September 2022 were included in this study. Dialysis nonattendance data were retrieved from the incident reports (DATIX) between December 2020 and November 2022, excluding dialysis nonattendance due to concurrent hospitalization. The cohort was split into group 1: no dialysis nonattendance; group 2: two or fewer dialysis nonattendances; and group 3: more than two dialysis nonattendances for comparative analysis. All patients were followed up for outcomes including all-cause mortality, transplantation, and hospitalizations until the study endpoint date of 12/31/2023. Predictors of dialysis nonattendance were identified using logistic regression.

Results

Of the 464 patients, dialysis nonattendance was noted in 149 (32%) patients, of which 79 (17%) had two dialysis nonattendance episodes and 70 (15%) had more than two dialysis nonattendance episodes. Over a median follow-up of 35 months, patients in group 3 had a higher hospitalization episode (4 vs. 1 day, p < 0.001) and lower kidney transplantation rates (4.3% vs. 13%, p = 0.038) compared to patients in group 1. In multivariate regression analysis, younger age (OR: 0.97; 95% CI: 0.95–0.98; p = 0.001), history of smoking (OR: 2.01; 95% CI: 1.12–3.62; p = 0.019), alcohol excess history (OR: 3.49; 95% CI: 1.87–6.49; p < 0.001) and history of mental health illness (OR: 3.01; 95% CI: 1.61–5.62; p = 0.001) were significant predictors of dialysis nonattendance.

Conclusion

Skipping HD is a common phenomenon associated with mental health issues and is associated with increased morbidity. Further research is required to understand the psychosocial determinants of nonadherence and effective models of intervention developed to improve outcomes.

Abstract Image

查看原文本刊更多论文

血液透析缺勤：英格兰西北部单一肾脏中心的患者特征和结果。

不参加规定的血液透析（HD）疗程是一种不依从的形式，损害了维持生命的HD治疗的交付，并与严重的发病率和死亡率相关。在这项研究中，我们旨在评估英格兰西北部单一肾脏中心的HD非参与者的特征和结果。方法：本研究纳入了2020年12月至2022年9月期间在我单位肾脏组随访的HD患者。从2020年12月至2022年11月的事件报告（DATIX）中检索透析缺勤数据，不包括因同时住院而导致的透析缺勤。该队列被分为第一组：无透析，不出席；第2组：两次或更少的透析缺席；第三组：两次以上未透析患者进行比较分析。所有患者的随访结果包括全因死亡率、移植和住院情况，直到研究终点日期2023年12月31日。使用逻辑回归确定透析缺勤的预测因素。结果：在464例患者中，149例（32%）患者不参加透析，其中79例（17%）有两次透析不参加，70例（15%）有两次以上透析不参加。在中位35个月的随访中，第3组患者住院次数较高（4天vs 1天）。结论：跳过HD是一种与心理健康问题相关的常见现象，并与发病率增加有关。需要进一步的研究来了解不依从的社会心理决定因素和开发有效的干预模式以改善结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Hemodialysis International UROLOGY & NEPHROLOGY-

CiteScore

2.50

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis. The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.