The highest facility-level comorbidity burden in hemodialysis centers was associated with a 10% higher risk of major adverse cardiac and cerebrovascular events compared to the lowest burden (HR 1.10).
Cohort (n=15,481)
Yes
Does a higher facility-level comorbidity burden increase the risk of MACCE and all-cause mortality in patients undergoing maintenance hemodialysis?
Higher facility-level comorbidity burden in hemodialysis centers is independently associated with an increased risk of major adverse cardiac and cerebrovascular events and all-cause mortality.
Effect estimate: HR 1.10 (95% CI 1.03-1.18)
Absolute Event Rate: 66.1% vs 62.4%
p-value: p=0.004
Background: The impact of facility-level comorbidity burden on the prognosis of hemodialysis patients remains unclear.This study aimed to investigate the association between facility-level comorbidity burden and hemodialysis outcomes.Methods: We examined 15,481 participants receiving hemodialysis at primary clinics participating in the Periodic Hemodialysis Quality Assessment by Health Insurance Review and Assessment Service in Korea.Facility-level comorbidity burden, defined as the sum of the Charlson Comorbidity Index of all patients divided by the number of nurses in each hemodialysis center, was the primary predictor.The primary outcome was major adverse cardiac and cerebrovascular events (MACCE).Results: During a median follow-up of 6.8 years, MACCE and all-cause mortality occurred in 9,797 (63.3%) and 8,513 participants (55.0%), respectively.Participants in the highest facility-level comorbidity burden had the highest incidence rates of both MACCE and all-cause mortality.Hazard ratios (HRs) of MACCE and all-cause mortality in the highest vs. the lowest quartile were 1.10 (95% confidence interval CI, 1.03-1.18)and 1.14 (95% CI, 1.06-1.22),respectively.Applying the facility-level comorbidity burden as a continuous variable, each 10-unit increase in facility-level comorbidity burden was associated with a 4% and 8% higher risk of MACCE and all-cause mortality, respectively.These associations remained consistent across subgroups.Conclusion: Our findings revealed that the facility-level comorbidity burden in hemodialysis centers was associated with a higher hazard of poor outcomes in patients undergoing hemodialysis.
Kim et al. (Fri,) conducted a cohort in End-stage kidney disease on maintenance hemodialysis (n=15,481). Highest facility-level comorbidity burden (Quartile 4) vs. Lowest facility-level comorbidity burden (Quartile 1) was evaluated on Major adverse cardiac and cerebrovascular events (MACCE) (HR 1.10, 95% CI 1.03-1.18, p=0.004). The highest facility-level comorbidity burden in hemodialysis centers was associated with a 10% higher risk of major adverse cardiac and cerebrovascular events compared to the lowest burden (HR 1.10).