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. 2018;139(1):1-12.
doi: 10.1159/000485985. Epub 2018 Jan 9.

Hospital Readmission among New Dialysis Patients Associated with Young Age and Poor Functional Status

LaTonya J Hickson  1   2 , Bjorg Thorsteinsdottir  3   2 , Priya Ramar  4   2 , Megan S Reinalda  5   2 , Cynthia S Crowson  5   2 , Amy W Williams  1 , Robert C Albright  1 , Macaulay A Onuigbo  6 , Andrew D Rule  1   2 , Nilay D Shah  4   2
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Hospital Readmission among New Dialysis Patients Associated with Young Age and Poor Functional Status

LaTonya J Hickson et al. Nephron. 2018.

Abstract

Background/aims: Over one-third of hospital discharges among dialysis patients are followed by 30-day readmission. The first year after dialysis start is a high-risk time frame. We examined the rate, causes, timing, and predictors of 30-day readmissions among adult, incident dialysis patients.

Methods: Hospital readmissions were assessed from the 91st day to the 15th month after the initiation of dialysis using a Mayo Clinic registry linkage to United States Renal Data System claims during the period January 2001-December 2010.

Results: Among 1,727 patients with ≥1 hospitalization, 532 (31%) had ≥1, and 261 (15%) had ≥2 readmissions. Readmission rate was 1.1% per person-day post-discharge, and the highest rates (2.5% per person-day) occurred ≤5 days after index admission. The overall cumulative readmission rate was 33.8% at day 30. Common readmission diagnoses included cardiac issues (22%), vascular disorders (19%), and infection (13%). Similar-cause readmissions to index hospitalization were more common during days 0-14 post-discharge than days 15-30 (37.5 vs. 22.9%; p = 0.004). Younger age at dialysis initiation, inability to transfer/ambulate, serum creatinine ≤5.3 mg/dL, higher number of previous hospitalizations, and longer duration on dialysis were associated with higher readmission rates in multivariable analyses. Patients aged 18-39 were few (8.3%) but comprised 17.7% of "high-readmission" users such that a 30-year-old patient had an 87% chance of being readmitted within 30 days of any hospital discharge, whereas an 80-year-old patient had a 25% chance.

Conclusions: Overall, 30-day readmissions are common within the first year of dialysis start. The first 10-day period after discharge, young patients, and those with poor functional status represent key areas for targeted interventions to reduce readmissions.

Keywords: Hospitalization; Cardiovascular disease; Death; Heart failure; Hemodialysis; Mortality; Youth.

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Conflict of interest statement

Disclosures/Statement of competing financial interests

The authors report no competing financial interests.

Disclosure: A.W.W. American Society of Nephrology Public Policy Board

Figures

Figure 1
Figure 1
(a) Distribution of 30-day readmission rates per person for incident hemodialysis patients with at least one 30-day readmission. (b) Incident hemodialysis readmission rate per person-day of follow-up according to days within the 30-day period after hospital discharge. Solid line is the readmission rate, expressed as a percentage, and the dashed lines are 95% confidence intervals.
Figure 1
Figure 1
(a) Distribution of 30-day readmission rates per person for incident hemodialysis patients with at least one 30-day readmission. (b) Incident hemodialysis readmission rate per person-day of follow-up according to days within the 30-day period after hospital discharge. Solid line is the readmission rate, expressed as a percentage, and the dashed lines are 95% confidence intervals.
Figure 2
Figure 2
(a) 30-day readmissions among incident hemodialysis patients classified as same-cause (black bars) or different-cause (white bars) discharge disease groups from the index hospitalization. (b) Number of incident hemodialysis patients with first 30-day readmission for the same-cause (black bars) or different-cause (white bars) discharge disease groups by days from index hospitalization to readmission.
Figure 2
Figure 2
(a) 30-day readmissions among incident hemodialysis patients classified as same-cause (black bars) or different-cause (white bars) discharge disease groups from the index hospitalization. (b) Number of incident hemodialysis patients with first 30-day readmission for the same-cause (black bars) or different-cause (white bars) discharge disease groups by days from index hospitalization to readmission.
Figure 3
Figure 3
Readmission rate per person-day, expressed as a percentage, according to number of previous hospitalizations among incident hemodialysis patients.
Figure 4
Figure 4
(a) Percentage of incident hemodialysis patients with at least one 30-day readmission according to low or high readmission rating by age groups. (b) Readmission rate per person (defined as rate per 30 days of follow-up), expressed as a percentage, according to age at start of maintenance hemodialysis therapy.
Figure 4
Figure 4
(a) Percentage of incident hemodialysis patients with at least one 30-day readmission according to low or high readmission rating by age groups. (b) Readmission rate per person (defined as rate per 30 days of follow-up), expressed as a percentage, according to age at start of maintenance hemodialysis therapy.
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References

    1. USRDS. United States Renal Data System 2014 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Bethesda, MD: Bethesda; 2014.
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