More Doctor Visits Good for Dialysis

Dialysis patients who see their doctor more often may be less likely to be hospitalized

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Dialysis can be a life-saving measure for kidney disease patients waiting for a transplant. While long-term dialysis has its risks, patients who see their doctor more often may do better.

Patients who visited their doctor four times a month had a slightly lower risk of hospitalization than those who visited less often, according to recent findings.

"See your doctor regularly if you're on dialysis."

In their study, Yelena Slinin, MD, of Veterans Administration Health Care System in Minneapolis, and colleagues set out to see if hemodialysis patients had better outcomes when they saw their doctor more often.

Despite their lower risk of hospitalization, patients with four doctor visits a month did not appear to have a lower risk of death than those with fewer visits.

The researchers also found that patients with four visits a month had at least a 2.3 percent lower risk of a first hospitalization, compared to those with fewer visits.

When a patient's kidneys fail, dialysis or transplantation is the next step in treatment. The hope is that a kidney failure patient can get a transplant, but new kidneys are in short supply. Dialysis can replace the function of kidneys, at least for a time. Unfortunately, the procedure has been linked to a number of risks, including hospitalization and death.

Patients get dialysis three times a week, but they only see their doctor at certain times. For the most part, dialysis appointments are carried out by nurses.

The study by Dr. Slinin and colleagues showed that doctor assessment visits may play an important role in reducing hospitalizations, at least when the visits happen four times a month.

"Reducing hospitalizations improves the quality of life of dialysis patients and potentially can save a substantial amount of healthcare spending," said Adam Powell, PhD, President of Payer+Provider Syndicate.

"When people are hospitalized, they are placed in an artificial environment in which there is a greater chance of acquiring an infection and greater disturbance to sleep. While the authors of the study suggested that reducing hospitalizations by 3% would save $104 million per year, it is possible that additional money would be saved due to a reduction in hospital-acquired infections. Furthermore, people are much more comfortable at home than in a hospital, as the activities of hospitals expose patients to noise, light, and examination every few hours around the clock, disrupting sleep and causing stress," said Dr. Powell, who was not involved in the study.

When dialysis patients saw their doctor four times a month, they had a lower risk of first hospitalization due to heart failure, cardiovascular problems, infections and vascular access complications (complications related to inserting dialysis tubes).

More specifically, patients seen four times a month had:

  • 1.02 percent lower risk of hospitalization for congestive heart failure
  • 1.61 percent lower risk of hospitalization for cardiovascular problems
  • 2.76 percent lower risk of hospitalization for infections
  • 2.26 percent lower risk of hospitalization for vascular access complications

"Overall, our study suggests that greater frequency of provider visits to hemodialysis patients is associated with a small but significant reduction in all-cause and cause-specific hospitalizations and recurrent hospitalizations," the authors concluded.

The research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases.

The authors disclosed no conflicts of interest.

The study was published September 1 in the Journal of the American Society of Nephrology.

Reviewed by: 
Review Date: 
September 24, 2012
Last Updated:
September 26, 2012