According to the United States Renal Data System 2011 annual data report, hospital admissions for infections were 43% higher in 2009 than in 1993.

The report includes detailed analyses of hospitalization rates among dialysis patients, including comparisons between HD and PD, rehospitalization rates, and reasons for admissions.

Highlights include:

• The rate for vascular access procedures has fallen 48%.

• Mortality rates for ESRD patients are 2 to 2.5 times greater than for Medicare patients with cancer, diabetes, or congestive heart failure.

• There is a 36% all-cause rehospitalization rate among hemodialysis patients, and the highest rates occur among patients 20 to 44 years old. Rates of rehospitalizations have changed little over the last decade.

• Hospitalization rates for ESRD patients are twice as high as in the general population. Mortality rates are improving, but more slowly for the first year of treatment than for the years following.

• In the peritoneal dialysis population, there has been little change in the overall rate of hospitalization for infections, but admissions for peritonitis have fallen.

• Rates of hospitalization in HD patients for skin and lung infections have been rising since 1993. The same rates in peritoneal and transplant patients have been falling.

• Dialysis Clinic Inc. has the lowest standardized hospitalization rates among large providers, and hospital based units have the rates among small providers.

• The use of catheters continues to be the number one cause of hospitalizations due to infection.

• In HD patients, cardiovascular admission rates have fallen 12% since 2004. The same rated for PD and transplant patients have fallen 14 and 19%.

• Admissions for vascular access infections are highest among the youngest patients.

• Admissions are highest among women, African Americans, older patients, and patients whose ESRD is caused by diabetes.

These data provide more evidence for the need for infection control and patient education. Since a large percentage of the hospitalizations are due to infections, and catheters are still the number one cause of infection, there is a clear need to for patients to see nephrologists sooner, since patients that do are more likely to have a fistula or a graft. Disparities in care for women and African Americans also need to be addressed.

It is also noteworthy that among the three largest dialysis providers, Dialysis Clinic Inc. has the lowest mortality rate. In addition to being the only non-profit of the three, it also maintains the most stable patient population, with most of its patients remaining under their care for longer than five years.