Readmission Among Dialysis Patients Carries Greater Risks, AHRQ Study Finds

Patients receiving dialysis who were hospitalized multiple times had a higher risk of poor outcomes than those who were not hospitalized or were only hospitalized once, an AHRQ-funded study has found. The study, published in BMC Nephrology, found that nearly one in five patients in the first year of dialysis were admitted to a hospital and then were readmitted within 30 days of discharge. Such patients were at substantially higher risk of subsequent hospitalization and death and a lower likelihood of kidney transplantation than other dialysis patients, researchers found. The authors concluded that identifying strategies to prevent readmission among dialysis patients may improve outcomes. Access the abstract.

2019 Jul 29;20(1):285. doi: 10.1186/s12882-019-1473-0.

Long-term outcomes among Medicare patients readmitted in the first year of hemodialysis: a retrospective cohort study.

Ross KH1, Jaar BG2,3,4,5, Lea JP6, Masud T6, Patzer RE1,6,7, Plantinga LC8,9.

Author information

1: Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA.
2: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
3: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
4: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
5: Nephrology Center of Maryland, Baltimore, MD, USA.
6: Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
7: Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
8: Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA. laura.plantinga@emory.edu.
9: Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. laura.plantinga@emory.edu.

Abstract

BACKGROUND:

Readmission within 30 days of hospital discharge is common and costly among end-stage renal disease (ESRD) patients. Little is known about long-term outcomes after readmission. We estimated the association between hospital admissions and readmissions in the first year of dialysis and outcomes in the second year.

METHODS:

Data on incident dialysis patients with Medicare coverage were obtained from the United States Renal Data System (USRDS). Readmission patterns were summarized as no admissions in the first year of dialysis (Admit-), at least one admission but no readmissions within 30 days (Admit+/Readmit-), and admissions with at least one readmission within 30 days (Admit+/Readmit+).We used Cox proportional hazards models to estimate the association between readmission pattern and mortality, hospitalization, and kidney transplantation, accounting for demographic and clinical covariates.

RESULTS:

Among the 128,593 Medicare ESRD patients included in the study, 18.5% were Admit+/Readmit+, 30.5% were Admit+/Readmit-, and 51.0% were Admit-. Readmit+/Admit+ patients had substantially higher long-term risk of mortality (HR = 3.32 (95% CI, 3.21-3.44)), hospitalization (HR = 4.46 (95% CI, 4.36-4.56)), and lower likelihood of kidney transplantation (HR = 0.52 (95% CI, 0.44-0.62)) compared to Admit- patients; these associations were stronger than those among Admit+/Readmit- patients.

CONCLUSIONS:

Patients with readmissions in the first year of dialysis were at substantially higher risk of poor outcomes than either patients who had no admissions or patients who had hospital admissions but no readmissions. Identifying strategies to both prevent readmission and mitigate risk among patients who had a readmission may improve outcomes among this substantial, high-risk group of ESRD patients.