Early Hospital Readmission Ups Hemodialysis Patient Mortality Risk

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Patients who are readmitted within 30 days of discharge are approximately twice as likely to die in the following year.
Patients who are readmitted within 30 days of discharge are approximately twice as likely to die in the following year.

Hemodialysis (HD) patients who are readmitted to a hospital within 30 days of discharge are at higher risk of death in the following year, according to a study.

Using a national registry, Laura C. Plantinga, PhD, of Emory University in Atlanta, and colleagues examined the timing of hospital readmissions of Medicare-covered HD patients and its association with mortality. The study cohort included 285,795 patients who had at least 1 hospitalization during 2010–2013 and survived 30 days or more after discharge from the index admission, defined as the first admission in the ascertainment period while the patient had primary Medicare coverage.

Overall, 23.1% of patients were readmitted within 30 days of the index discharge, Dr Plantinga's team reported online ahead of print in Kidney International. Of these, 35.9%, 23.9%, and 40.2% occurred within 0–7, 8–14, and 15–30 days, respectively. Compared with patients who had no readmissions, those who were readmitted had an approximately 2-fold higher risk of death within 1 year, regardless of readmission timing.

“This differential in risk, which was independent of patient and index admission characteristics, indicates that readmission may serve as a proxy of declining function (resulting in not only declining overall health but also reduced ability to manage health independently) in the period before death,” the investigators wrote.

The finding that 35.9% of readmissions occur within 1 week suggests that dialysis providers have limited opportunities to intervene and prevent early readmissions, the researchers concluded. This could have implications for dialysis providers because they may soon be held accountable for their patients' 30-day hospital readmissions under the Hospital Readmissions Reduction Program, which was established by the Centers for Medicare & Medicaid Services as part of the Affordable Care Act, according to investigators. Few studies have evaluated the timing of readmissions, a factor that determines the window during which dialysis providers could act to prevent readmission.

Reference

Plantinga LC, King L,. Patzer RE et al. Early hospital readmission among hemodialysis patients in the United States is associated with subsequent mortality. Kidney Int 2017;published online ahead of print.

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