Association of Maintenance Hemodialysis with Transfer to Post-Acute Rehabilitation After Stroke: A Single-Center Retrospective Cohort Study.

Abstract

Background/objectives: Maintenance hemodialysis (HD) is associated with poor outcomes after stroke, but its association with access to post-acute rehabilitation remains unclear. We examined rehabilitation transfer and outcomes according to maintenance HD status.

Methods: This single-center retrospective cohort included consecutive stroke patients admitted to a tertiary emergency care center during 2015-2023. The primary outcome was rehabilitation transfer among in-hospital survivors. Rehabilitation eligibility and reasons for non-transfer were assessed in the HD group. Firth logistic regression evaluated rehabilitation transfer, and multivariable logistic regression evaluated in-hospital mortality and favorable functional outcome.

Results: Among 1173 patients, 54 received maintenance HD. Rehabilitation transfer occurred in 2 of 33 HD survivors (6.1%) and 299 of 937 non-HD survivors (31.9%; risk ratio, 0.19; 95% confidence interval [CI], 0.05-0.62; p < 0.001). After adjustment using Firth logistic regression, maintenance HD remained associated with lower odds of rehabilitation transfer (adjusted odds ratio [aOR], 0.21; 95% CI, 0.04-0.65; p = 0.005). Of 12 rehabilitation-eligible HD patients, 2 (16.7%) were transferred; no facility providing both maintenance HD and inpatient rehabilitation could be secured for the other 10. Maintenance HD was associated with higher in-hospital mortality (aOR, 4.26; 95% CI, 2.20-8.24; p < 0.001) and lower odds of a favorable functional outcome (aOR, 0.38; 95% CI, 0.19-0.77; p = 0.007).

Conclusions: Maintenance HD was associated with markedly lower rehabilitation transfer and poorer acute outcomes. Expanding access to facilities integrating dialysis and rehabilitation may improve continuity and equity of post-stroke care.