WASHINGTON — A speaker at ASN Kidney Week provided what she called “a different perspective on hospitalization risk,” telling the audience that considering psychosocial factors may help with interventions aimed at reducing the risk of hospitalization for patients on hemodialysis.
For their research, Nancy G. Kutner, PhD, of Emory University School of Medicine in Georgia, and colleagues sought to determine if psychosocial factors — not captured in large databases dependent on electronic medical records — could be useful hospitalization risk score predictors.
“What might a study with a dataset that has more granular, patient-level data tell us?” she said in a presentation. “I thought immediately of what we could learn from the ACTIVE-ADIPOSE study, which was the last United States Renal Data System study that actually collected data directly from patients.”
Including 759 patients from 14 outpatient dialysis clinics, the study consisted of both patient interviews and medical records. Researchers looked at sociodemographic characteristics and comorbidity to estimate the association of age, smoking and hemodialysis treatment adherence with all-cause hospitalization burden.
They found the odds for hospitalization were increased for younger patients, smokers and those who more frequently skipped hemodialysis sessions.
Regarding smoking status, researchers noted that participants who were current smokers were younger and reported elevated depressive symptoms more often than non-smokers. In addition, smokers skipped twice the amount of treatment sessions compared with non-smokers.
Kutner said it is important to remember younger age, smoking and skipping dialysis sessions are “highly interrelated variables” that can each be viewed as a psychosocial element.
“If you’re younger, you tend to feel that you’re healthy,” she said. “You want to believe that you are healthy and that you can get away, perhaps, with nonadherence. If you skip treatments, this might be an expression of needing to feel in control of your life or to deal with some depressive symptoms. As for smoking, it has been called a marker for low priority of health maintenance.”
She concluded, “The most important question might be: How well can the person manage what might be called the ‘compliance/independence tightrope?’ If you’re trying to provide patients with more frequent physician visits to address the risk for rehospitalization, this might be a really important thing to focus on, particularly in the complex, high-risk patient.” – by Melissa J. Webb
Kutner NG, et al. Abstract SA-OR062. Presented at: ASN Kidney Week; Nov. 7-10, 2019; Washington, D.C.
Disclosure: Kutner reports no relevant financial disclosures.