Infection-related hospitalization of hemodialysis patients

Infection is an important cause of morbidity and mortality in hemodialysis patients. These patients are frequently hospitalized for infections. The objective of our study was to evaluate hospitalization rate for infections and to determine risk factors for infection-related hospitalizations of hemodialysis patients in Kaunas region, Lithuania. Ambulatory case records of 533 patients with end-stage renal disease, dialyzed in all hemodialysis centers in Kaunas region during the period of 2001–2004, were analyzed. Data on patient’s condition and routine laboratory tests were collected in November of 2001, 2002, and 2003. These patients then were followed up for the next 12 months in order to evaluate infection-related hospitalization rate. All patients were considered new patients every year, and general analysis of three-year data was performed. Statistical analyses were carried out using SPSS (Statistical Package for Social Sciences) and STATISTICA. Univariate statistical analysis was performed comparing the groups of patients that were hospitalized because of infections and were not hospitalized. Relative risk of infection-related hospitalization was estimated using Cox regression evaluating the time to first infection-related hospitalization. The unadjusted infection-related hospitalization rate was 0.2 per patient a year (18% of all hospitalizations). The median length of hospital stay for infections was 11 days. Univariate statistical analysis showed a statistically significant association between infection-related hospitalizations and diabetes (P=0.02); lower hemoglobin (P<0.0001), creatinine (P=0.045), and albumin (P=0.01) concentrations; higher interdialytic weight gain (P=0.01). Multivariate Cox regression analysis revealed that only hemoglobin concentration (P<0.001, RR=0.96), interdialytic weight gain (P=0.002, RR=1.38), and creatinine level (P=0.02, RR=0.99) were important risk factors for infection-related hospitalization [...]

Estimated average yearly treatment expenditures for hemodialysis patients (Data of Kaunas University of Medicine Hospital in the year 2005)

With increasing number of hemodialysis patients, expenditures for the treatment of hemodialysis patients are rising every year. The objective of our study was to collect and analyze the data on estimated average treatment expenditures, which were covered by State Patients’ Fund, for patients undergoing hemodialysis in Kaunas University of Medicine Hospital in 2005 and the costs of medications paid by patient and to compare with the analogical data of the year 2001. We analyzed ambulatory case records of all 106 patients with end-stage renal disease who were hemodialyzed in Kaunas University of Medicine Hospital from November 1, 2004, to October 31, 2005. Data on medications used and number of hemodialysis procedures and hospitalizations were collected. On average, 2.8±0.4 hemodialysis procedures per patient a week were carried out. Expenditures for hemodialysis procedures were 38 094.12±5003.17 litas (11 041 euros) per patient per year, and this accounted for 63% of all expenditures for hemodialysis patient. Hospitalization rate was 1.4±1.8 per patient a year; expenditures for hospitalizations were 1538.4±1941 litas (446 euros) per patient a year (3% of all expenditures for hemodialysis patients). The mean number of drugs prescribed per patient monthly was 7.7±2.17 including 2.12±1.6 antihypertensive medications. The total costs of drugs reimbursed by State Patients’ Fund were 20 639.82±15 439.3 litas (5983 euros) per patient per year, of which 92% was spent on erythropoietin and intravenous iron. The average expenditures for health insurance of hemodialysis patients were 60 272.35±16 624.18 litas (17 470 euros) per patient a year. One patient had to pay 1.9±1.6 litas for medications per day and 699.71±583.6 litas (203 euros) per year. The comparison of the data gathered in 2001 and 2005 revealed an increase in the total expenditures for hemodialysis patients due to increase in the expenditures for hemodialysis procedures and medications

Influence of anemia on hospitalization and mortality in hemodialysis patients

The objective of our study was to evaluate the influence of anemia on hospitalization and mortality in hemodialysis patients of Kaunas region. We analyzed ambulatory case records of 148 patients dialyzed in all 7 hemodialysis centers of Kaunas region in November 2001. The study consisted of two parts: in the first part data on patient age, gender, primary cause of end-stage renal disease, hemoglobin concentration were collected in November 2001 and in the second part these patients were followed up for 12 months in order to evaluate rate and length of hospitalization, reasons for hospitalization and mortality. At the beginning of the study mean hemoglobin (Hb) value was 101.2±13.8 g/l and more than a half of the patients (59%) had hemoglobin value higher than 100 g/l. Further follow-up of the patients during the year 2002 revealed that hemoglobin level of the patients who died was lower from the patients who followed hemodialysis. Mean hemoglobin of dead and alive patients was 92.4±18.6 g/l and 102.81±12.48 g/l, respectively (p=0.02). Lower hemoglobin concentrations were associated with a 5% higher relative risk of mortality for every 1 g/l decrease in hemoglobin (p=0.027). Analysis showed that mean hemoglobin value was 104.2±11.1 g/l for the patients who were not hospitalized and 99±15.1 g/l for the patients who were hospitalized during the year 2002 (p=0.02). Lower hemoglobin concentrations were associated with a 5% higher relative risk for hospitalization for every 1 g/l decrease in hemoglobin (p=0.027). Patients who had mean hemoglobin value lower than 100g/l were hospitalized more frequently (p=0.01) and for longer period of time (p=0.005) than the patients with hemoglobin higher than 100 g/l. Analysis of the reasons for hospitalizations revealed that every 1 g/l decrease in hemoglobin increases relative risk for hospitalization due infections by 1% (p=0.000)

Acquired immunodeficiency syndrome and opportunistic infections

This article presents a clinical case of late diagnosis of cerebral toxoplasmosis and cytomegalovirus retinitis of right eye in a 32-year-old patient who was unaware of her HIV status. In addition, this article reviews the literature reflecting clinical, diagnostic, and treatment issues of some opportunistic infections in AIDS