Post on 24-Jun-2015
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Admission Patterns for Danish ESRD Patients 1990-2003
• DNS National Register and National Patient Register merged
• 9317 patients• 232,760 admissions• 167,217 admissions after ESRD• Average admission duration 6.7 days• 3081 hospital years• TUS classifications: HD, PD, Transplantation• 60-day collapsing rule for dialysis courses
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Temporal Changes in Diagnosis Registration
• ICD-10 1994• DRG ca. 2001• Medical ”Fashions”• Illogical Codes
Hyperparathyreoidismus secundarius E21.1Hyperparathyreoidismus non spec E21.3Osteodystrophia renalis N25.0Hyperparathyreoidismus renalis N25.8
• Changes in Admission Practice• Late registration (>10 months)
ESRD Beds
020406080
100120140160180200
Ad
mis
sio
n Y
ears
1990 1992 1994 1996 1998 2000 2002
YearAll ESRD
Admission Number
2
2,2
2,4
2,6
2,8
3
3,2
3,4
3,6
Ad
mis
sio
ns/
pat
ien
t/ye
ar
1990 1992 1994 1996 1998 2000 2002
YearAll ESRD
Admission Days
10
12
14
16
18
20
22
24
Ad
mis
sio
n D
ays
/pat
ien
t/ye
ar
1990 1992 1994 1996 1998 2000 2002
YearAll ESRD
Admission Age
5051525354555657585960
Ag
e o
n A
dm
issi
on
(yr
s)
1990 1992 1994 1996 1998 2000 2002
Year
Admission Days: Therapy
5
10
15
20
25
30
35
40
Ad
mis
sio
n D
ay
s
/pa
tie
nt/
ye
ar
1990 1992 1994 1996 1998 2000 2002
Year
HD PD Transplant
Admission Days: Age
5
10
15
20
25
30
35
40
Ad
mis
sio
n D
ay
s
/pa
tie
nt/
ye
ar
<20 20-30 30-40 40-50 50-60 60-70 70-80 >80
Age
HD PD Transplant
Admission Duration: Age
2
3
4
5
6
7
8
9
10
Ad
mis
sio
n D
ay
s /
Ad
mis
sio
n
<20 20-30 30-40 40-50 50-60 60-70 70-80 >80
Age
HD PD Transplant
Admission Number: Therapy Vintage
0
1
2
3
4
5
6
7
Ad
mis
sio
ns/
pat
ien
t/ye
ar
1 2 3 4 5 6 7 8 9 10 >10
Year after Therapy Change
HD PD Transplant
RRT Start>1989
Admission Days: Therapy Vintage
5
10
15
20
25
30
35
40
45
50
Ad
mis
sio
n D
ays
/pat
ien
t/ye
ar
1 2 3 4 5 6 7 8 9 10 >10
Year after Therapy Change
HD PD Transplant RRT Start>1989
Admission No.: HD Therapy Number
0
1
2
3
4
5
6
7
Ad
mis
sio
ns/
pat
ien
t/ye
ar
1 2 3 4 5 6 7
Year after Therapy Change
1. Course 2. Course 3. Course
RRT Start>1989
Admission Days: HD Therapy Number
5
10
15
20
25
30
35
40
45
50
Ad
mis
sio
n D
ays
/pat
ien
t/ye
ar
1 2 3 4 5 6 7
Year after Therapy Change
1. Course 2. Course 3. Course
RRT Start>1989
Admission No.: PD Therapy Number
0
1
2
3
4
5
6
7
Ad
mis
sio
ns/
pat
ien
t/ye
ar
1 2 3 4 5 6 7
Year after Therapy Change
1. Course 2. Course
RRT Start>1989
Admission Days: PD Therapy Number
5
10
15
20
25
30
35
40
Ad
mis
sio
n D
ays
/pat
ien
t/ye
ar
1 2 3 4 5 6 7
Year after Therapy Change
1. Course 2. Course
RRT Start>1989
Admission Number: Renal Diagnosis
0
1
2
3
4
5
6
7
8A
dm
issi
on
s/p
atie
nt/
year
Sm
all
GN
CIN
PC
N
Art
scl
DM
Can
cer
Vas
culit
is
RRT Start>1989
Admission Days: Renal Diagnosis
0
10
20
30
40
50
Ad
mis
sio
ns/
pat
ien
t/ye
ar
Sm
all
GN
CIN
PC
N
Art
scl
DM
Can
cer
Vas
culi
tis
HD PD Transplant
RRT Start>1989
ICD-10
Dialysis Only
Fracture Incidence
0
1
2
3
Fra
ctu
res/
pat
ien
t/yr
(%
)
1990 1992 1994 1996 1998 2000 2002
Year
Osteodystrophy Diagnoses
0
0,2
0,4
0,6
0,8
1
1,2
1,4
90 91 92 93 94 95 96 97 98 99 0 1 2 3
PTH BoneFractures
Dialysis Only Year
Ad
msi
ssio
n D
ays/
Yea
r
00,20,40,60,8
11,21,41,6N
o./
100
pat
ien
ts/Y
ear
90 92 94 96 98 0 2
Year
Pericarditis
Dialysis Only
Infectious Diagnoses
-1
1
3
5
90 92 94 96 98 0 2
Year
Ad
mis
sio
n d
ay
s/y
ea
r
Access Problem
Peritonitis
OperationComplicationPneumonia
Infection
Dialysis Only
Circulatory Diagnoses
0
1
2
3
4
90 92 94 96 98 0 2Year
Ad
mis
sio
n d
ay
s/y
ea
r
Heart Failure
Pulmonary Edema
Peripheral
Cerebrovasc
Ischemic Heart
AMI
Heart
Dialysis Only
Previous Year Admission and Mortality
05
101520253035404550
2-ye
ar M
ort
alit
y (%
)
None <1 week 1-2weeks
2-3weeks
3-4weeks
1-2months
>2months
Admission Time during Previous Year before ESRD
Mortality Risk at ESRD
Increased Risk in percent
(Confidence Interval)
Significance
Previous year admissions (weeks)
4.3 (3.7-4.9) <0.0001
Female 1.9 (-5 to +8.6) NS
Age (years) 5.3 (5.1-5.6) <0.0001
Nephrosclerosis 19 (7.1-32) <0.002
Other systemic renal disease (primarily DM)
69 (58-82) <0.0001