Background: Haemodialysis (HD) is the dominant form of kidney replacement therapy for 84% of all new patients with kidney failure. Hospitalisation rates for these patients are 7-fold higher than the general population and a major accelerant of mortality and reduced quality life. The underlying reasons for these high rates of morbidity in HD remain unclear but evidence points to a combination of patient and dialysis-related factors. It is speculated that a large proportion of hospitalisations are potentially preventable or avoidable. The identification of modifiable factors that predict hospitalisations would pave the way for novel upstream prevention strategies.
Hypothesis: We hypothesize that the high rates of hospitalisations for patients on HD are a consequence of measurable patient-level and dialysis-related factors that can be clearly defined at dialysis initiation and following the commencement of treatment, and that these rates can be reduced by generating risk-prediction models that target avoidable hospitalisations.
Research Plan: A multi-agency & multi-institutional consortium with clinical, academic and patient partners will lead the first national study to better understand the major drivers of hospitalisation for patients treated with HD in Ireland. Comprehensive surveillance of national cohorts within the National Kidney Disease Surveillance programme, an entrusted research environment, will describe the magnitude, patterns, impact and cost of HD-associated hospitalisations in the health system. We will explore the relative contributions of patient-level and treatment-related factors on rates of hospitalisations and subsequent mortality and will generate risk models to predict all-cause, avoidable, and recurrent hospitalisations. This programme of research will provide important new knowledge on the clinical and economic consequences of HD in Ireland. It will directly inform national policy on prevention strategies by generating clinical risk models that have the potential to reduce avoidable hospitalisations.”