Association of Maintenance Hemodialysis with Transfer to Post-Acute Rehabilitation After Stroke: A Single-Center Retrospective Cohort Study.
- 1Department of Disaster and Emergency Medicine, Kochi University, Nankoku 783-8505, Japan.
- 2Department of Advanced Emergency and Critical Care Center, Nippon Medical School Hospital, Tokyo 113-8603, Japan.
Abstract
Background/objectives
Maintenance hemodialysis (HD) is associated with poor outcomes after stroke, but its association with access to post-acute rehabilitation remains unclear. We examined rehabilitation transfer and outcomes according to maintenance HD status.Methods
This single-center retrospective cohort included consecutive stroke patients admitted to a tertiary emergency care center during 2015-2023. The primary outcome was rehabilitation transfer among in-hospital survivors. Rehabilitation eligibility and reasons for non-transfer were assessed in the HD group. Firth logistic regression evaluated rehabilitation transfer, and multivariable logistic regression evaluated in-hospital mortality and favorable functional outcome.Results
Among 1173 patients, 54 received maintenance HD. Rehabilitation transfer occurred in 2 of 33 HD survivors (6.1%) and 299 of 937 non-HD survivors (31.9%; risk ratio, 0.19; 95% confidence interval [CI], 0.05-0.62; p < 0.001). After adjustment using Firth logistic regression, maintenance HD remained associated with lower odds of rehabilitation transfer (adjusted odds ratio [aOR], 0.21; 95% CI, 0.04-0.65; p = 0.005). Of 12 rehabilitation-eligible HD patients, 2 (16.7%) were transferred; no facility providing both maintenance HD and inpatient rehabilitation could be secured for the other 10. Maintenance HD was associated with higher in-hospital mortality (aOR, 4.26; 95% CI, 2.20-8.24; p < 0.001) and lower odds of a favorable functional outcome (aOR, 0.38; 95% CI, 0.19-0.77; p = 0.007).Conclusions
Maintenance HD was associated with markedly lower rehabilitation transfer and poorer acute outcomes. Expanding access to facilities integrating dialysis and rehabilitation may improve continuity and equity of post-stroke care.
Related
- Association of hemodialysis vascular access type with dialysis adequacy and access-related outcomes in patients receiving maintenance hemodialysis.
- Changes in Nutritional Status and Bioimpedance Parameters During EAA/KA Supplementation in Elderly Patients Undergoing Maintenance Hemodialysis: A Retrospective Observational Study
- Systemic inflammatory response index as an independent predictor of all-cause mortality in patients receiving maintenance hemodialysis: a retrospective cohort study
- Blood pressure variability and serum sodium for long-term mortality risk stratification in maintenance hemodialysis patients: a real-world retrospective cohort study
- Association of Serum Visfatin Levels with Coronary Artery Disease and Biochemical Parameters in Patients Undergoing Maintenance Hemodialysis
BibTeX
@article{onda2026association,
title = {{Association of Maintenance Hemodialysis with Transfer to Post-Acute Rehabilitation After Stroke: A Single-Center Retrospective Cohort Study.}},
author = {Hidetaka Onda and Shoji Yokobori and Masato Miyauchi},
journal = {Healthcare (Basel, Switzerland)},
year = {2026},
month = oct,
doi = {10.3390/healthcare14193303},
url = {https://europepmc.org/article/MED/42881742},
note = {CC BY},
}
RIS
TY - JOUR
TI - Association of Maintenance Hemodialysis with Transfer to Post-Acute Rehabilitation After Stroke: A Single-Center Retrospective Cohort Study.
AU - Hidetaka Onda
AU - Shoji Yokobori
AU - Masato Miyauchi
PY - 2026
DA - 2026/10/03
JO - Healthcare (Basel, Switzerland)
DO - 10.3390/healthcare14193303
UR - https://europepmc.org/article/MED/42881742
AB - Background/objectives Maintenance hemodialysis (HD) is associated with poor outcomes after stroke, but its association with access to post-acute rehabilitation remains unclear. We examined rehabilitation transfer and outcomes according to maintenance HD status.Methods This single-center retrospective cohort included consecutive stroke patients admitted to a tertiary emergency care center during 2015-2023. The primary outcome was rehabilitation transfer among in-hospital survivors. Rehabilitation eligibility and reasons for non-transfer were assessed in the HD group. Firth logistic regression evaluated rehabilitation transfer, and multivariable logistic regression evaluated in-hospital mortality and favorable functional outcome.Results Among 1173 patients, 54 received maintenance HD. Rehabilitation transfer occurred in 2 of 33 HD survivors (6.1%) and 299 of 937 non-HD survivors (31.9%; risk ratio, 0.19; 95% confidence interval [CI], 0.05-0.62; p < 0.001). After adjustment using Firth logistic regression, maintenance HD remained associated with lower odds of rehabilitation transfer (adjusted odds ratio [aOR], 0.21; 95% CI, 0.04-0.65; p = 0.005). Of 12 rehabilitation-eligible HD patients, 2 (16.7%) were transferred; no facility providing both maintenance HD and inpatient rehabilitation could be secured for the other 10. Maintenance HD was associated with higher in-hospital mortality (aOR, 4.26; 95% CI, 2.20-8.24; p < 0.001) and lower odds of a favorable functional outcome (aOR, 0.38; 95% CI, 0.19-0.77; p = 0.007).Conclusions Maintenance HD was associated with markedly lower rehabilitation transfer and poorer acute outcomes. Expanding access to facilities integrating dialysis and rehabilitation may improve continuity and equity of post-stroke care.
SN - 2227-9032
ER -