Unplanned Readmissions of Hemodialysis Patients Probed

Readmissions in HD patients are high regardless of why patients are initially admitted to the hospital.
Readmissions in HD patients are high regardless of why patients are initially admitted to the hospital.

ORLANDO, Fla.—Nearly one fourth of hospitalizations of maintenance hemodialysis (HD) patients are followed by unplanned readmissions, according to study findings presented at the National Kidney Foundation's 2017 Spring Clinical Meetings. Most of these readmissions were for reasons that differed from the initial hospitalization.

Of 390,627 index admissions of maintenance HD patients identified using a large nationally representative all-payer database, 87,301 (22.3%) were followed by readmission within 30 days, Lili Chan, MD, of the Icahn School of medicine at Mount Sinai in New York, and colleagues reported.

Implant complications, predominantly vascular access complications, were the most common reason for index admissions, followed by hypertension and sepsis. Index admissions with the highest readmission rates were for acute myocardial infarction (25.4%), diabetes mellitus (24.8%), and congestive heart failure (24.6%). A similar readmission rate was found regardless of index admission diagnosis. Results showed that 2.3% of the study population was responsible for 20% of all readmissions, which the investigators termed “high utilizers.” The investigators defined unplanned readmissions as any readmissions within 30 days of an index admission after excluding those flagged as elective.

Factors significantly and independently associated with increased odds of unplanned 30-day readmission included younger age, female gender, depression, drug abuse, and discharge against medical advice. Interventions to reduce the number of readmissions should be targeted to patients with these characteristics and to those who are high utilizers, the investigators stated.

The primary reason for the index hospitalization and subsequent 30-day readmission were discordant in 79.5% of admissions.

Readmissions in dialysis patients have been identified by the Centers for Medicare and Medicaid Services as an area for quality improvement, the researchers noted.

“Readmissions in HD patients are high regardless of why patients are initially admitted to the hospital,” Dr Chan told Renal & Urology News. “Psychosocial factors such as depression and drug abuse are associated with higher odds of readmissions with similar or higher adjusted odds ratios as organic diseases such as liver disease and congestive heart failure. Better screening and treatment of psychosocial factors may have a significant impact on readmissions across a broad spectrum of admission diagnoses.”

See more coverage from the National Kidney Foundation Spring Clinical meeting.


Reference

Chan L, Chauhan K, Poojary P, et al. National estimates of thirty day unplanned readmissions in patients on maintenance hemodialysis. Poster presented at the National Kidney Foundation's 2017 Spring Clinical Meetings in Orlando, Florida. Poster 206

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