Table 3.
Association of attainment of 6-month clinical performance targets with hospital admissions and hospital days
| Target | Average per follow-up year* | Incidence Rate Ratio (95% Confidence Interval) | ||
| Unadjusted | Multivariate Adjusted** | Propensity Score Adjusted*** | ||
| NUMBER OF HOSPITALIZATIONS | ||||
| Individual Targets | ||||
| Albumin ≥4.0 g/dl (N = 650) | ||||
| Target not attained | 2.2 | 1.00 (Ref.) | 1.00 (Ref.) | 1.00 (Ref.) |
| Target attained | 1.4 | 0.62 (0.57–0.67) | 0.67 (0.62–0.73) | 0.81 (0.73–0.89) |
| P | <0.001 | <0.001 | 0.001 | <0.001 |
| Ca-P Product <55 mg2/dl2 (N = 648) | ||||
| Target not attained | 2.1 | 1.00 (Ref.) | 1.00 (Ref.) | 1.00 (Ref.) |
| Target attained | 1.9 | 0.88 (0.82–0.95) | 0.86 (0.79–0.92) | 0.80 (0.74–0.86) |
| P | 0.374 | 0.001 | <0.001 | <0.001 |
| Hemoglobin ≥11 g/dl (N = 644) | ||||
| Target not attained | 2.1 | 1.00 (Ref.) | 1.00 (Ref.) | 1.00 (Ref.) |
| Target attained | 1.8 | 0.85 (0.79–0.91) | 0.82 (0.76–0.88) | 0.81 (0.75–0.87) |
| P | 0.146 | <0.001 | <0.001 | <0.001 |
| Dialysis Dose, Kt/V≥1.2 (N = 539) | ||||
| Target not attained | 1.9 | 1.00 (Ref.) | 1.00 (Ref.) | 1.00 (Ref.) |
| Target attained | 1.9 | 1.00 (0.89–1.13) | 0.99 (0.88–1.12) | 0.86 (0.75–0.99) |
| P | 0.796 | 0.970 | 0.902 | 0.040 |
| Access Type, fistula (N = 424) | ||||
| Target not attained | 2.0 | 1.00 (Ref.) | 1.00 (Ref.) | 1.00 (Ref.) |
| Target attained | 1.4 | 0.73 (0.66–0.81) | 0.79 (0.71–0.88) | 0.86 (0.77–0.97) |
| P | 0.016 | <0.001 | <0.001 | 0.011 |
| Albumin, Ca-P, and Hemoglobin Targets (N = 643) | ||||
| 0 targets attained | 2.6 | 1.00 (Ref.) | 1.00 (Ref.) | 1.00 (Ref.) |
| 1 target attained | 2.1 | 0.69 (0.61–0.76) | 0.69 (0.62–0.78) | 0.59 (0.53–0.66) |
| 2 targets attained | 1.8 | 0.62 (0.56–0.70) | 0.62 (0.55–0.69) | 0.57 (0.51–0.65) |
| 3 targets attained | 1.3 | 0.43 (0.37–0.50) | 0.44 (0.38–0.51) | 0.39 (0.33–0.46) |
| P for trend | <0.001 | <0.001 | <0.001 | <0.001 |
| All Five Targets (N = 344) | ||||
| 0–1 targets attained | 2.4 | 1.00 (Ref.) | 1.00 (Ref.) | 1.00 (Ref.) |
| 2 targets attained | 2.3 | 0.96 (0.82–1.14) | 0.88 (0.74–1.05) | 1.01 (0.85–1.19) |
| 3 targets attained | 1.7 | 0.71 (0.60–0.84) | 0.67 (0.57–0.80) | 0.76 (0.64–0.90) |
| 4–5 targets attained | 1.1 | 0.55 (0.45–0.66) | 0.55 (0.43–0.67) | 0.65 (0.53–0.80) |
| P for trend | <0.001 | <0.001 | <0.001 | <0.001 |
| DAYS HOSPITALIZED | ||||
| Individual Targets | ||||
| Albumin ≥4.0 g/dl (N = 647) | ||||
| Target not attained | 13.0 | 1.00 (Ref.) | 1.00 (Ref.) | 1.00 (Ref.) |
| Target attained | 7.4 | 0.55 (0.53–0.57) | 0.61 (0.58–0.63) | 0.76 (0.72–0.79) |
| P | <0.001 | <0.001 | <0.001 | <0.001 |
| Ca-P Product <55 mg2/dl2 (N = 645) | ||||
| Target not attained | 11.6 | 1.00 (Ref.) | 1.00 (Ref.) | 1.00 (Ref.) |
| Target attained | 11.1 | 0.89 (0.87–0.92) | 0.85 (0.83–0.88) | 0.79 (0.77–0.82) |
| P | 0.719 | <0.001 | <0.001 | <0.001 |
| Hemoglobin ≥11 g/dl (N = 641) | ||||
| Target not attained | 11.7 | 1.00 (Ref.) | 1.00 (Ref.) | 1.00 (Ref.) |
| Target attained | 11.0 | 0.92 (0.90–0.95) | 0.89 (0.86–0.92) | 0.89 (0.86–0.91) |
| P | 0.571 | <0.001 | <0.001 | <0.001 |
| Dialysis Dose, Kt/V≥1.2 (N = 537) | ||||
| Target not attained | 9.3 | 1.00 (Ref.) | 1.00 (Ref.) | 1.00 (Ref.) |
| Target attained | 11.6 | 1.12 (1.06–1.18) | 1.11 (1.05–1.17) | 0.89 (0.84–0.95) |
| P | 0.225 | <0.001 | <0.001 | <0.001 |
| Access Type, fistula (N = 420) | ||||
| Target not attained | 12.3 | 1.00 (Ref.) | 1.00 (Ref.) | 1.00 (Ref.) |
| Target attained | 7.3 | 0.65 (0.62–0.67) | 0.72 (0.69–0.75) | 0.79 (0.75–0.82) |
| P | 0.004 | <0.001 | <0.001 | <0.001 |
| Albumin, Ca-P, and Hemoglobin Targets (N = 640) | ||||
| 0 targets attained | 13.9 | 1.00 (Ref.) | 1.00 (Ref.) | 1.00 (Ref.) |
| 1 target attained | 11.7 | 0.69 (0.66–0.72) | 0.70 (0.67–0.73) | 0.61 (0.59–0.64) |
| 2 targets attained | 11.9 | 0.70 (0.67–0.73) | 0.70 (0.66–0.73) | 0.67 (0.63–0.70) |
| 3 targets attained | 6.0 | 0.37 (0.34–0.39) | 0.37 (0.35–0.40) | 0.35 (0.33–0.38) |
| P for trend | 0.001 | <0.001 | <0.001 | <0.001 |
| All Five Targets (N = 341) | ||||
| 0–1 targets attained | 13.2 | 1.00 (Ref.) | 1.00 (Ref.) | 1.00 (Ref.) |
| 2 targets attained | 14.3 | 0.95 (0.89–1.01) | 0.87 (0.82–0.94) | 1.00 (0.94–1.07) |
| 3 targets attained | 10.4 | 0.71 (0.66–0.75) | 0.67 (0.63–0.72) | 0.77 (0.72–0.83) |
| 4–5 targets attained | 4.8 | 0.41 (0.38–0.44) | 0.43 (0.40–0.47) | 0.50 (0.46–0.55) |
| P for trend | <0.001 | <0.001 | <0.001 | <0.001 |
For hospital admissions, mean at-risk follow-up (excluding days in the hospital when patients could not be admitted) was 3.1 years (median, 3.0 years); for hospital days, mean at-risk follow-up was 3.2 years (median, 3.1 years). Statistically significant values are in boldface type.
*P by t test (individual targets) or nonparametric trend test (multiple targets).
**Adjusted for first value of target(s) indicated, age, race, index of co-existent disease, and albumin.
***Propensity score models consisted of:
Albumin target: age, sex, index of co-existent disease, baseline albumin, creatinine, and C-reactive protein;
Ca-P target: age, sex, employment, index of co-existent disease, creatinine, hemoglobin, and baseline Ca-P;
Hemoglobin target: age, sex, race, body mass index, and baseline hemoglobin;
Dialysis dose target: age, sex, race, body mass index, Kt/V, creatinine, hemoglobin, and Ca-P;
Access target: age, sex, race, index of co-existent disease, albumin, creatinine, and C-reactive protein;
Albumin, Ca-P, and hemoglobin targets: age, sex, index of co-existent disease, body mass index, baseline albumin, baseline hemoglobin, baseline Ca-P, and C-reactive protein; and
All five targets: age, sex, index of co-existent disease, body mass index, baseline Kt/V, baseline albumin, baseline hemoglobin, baseline Ca-P, and C-reactive protein.