Unplanned Readmissions Occur in One-Fourth of ESRD Patients

Almost a fourth of patients with end stage renal disease (ESRD) receiving hemodialysis experienced at least 1 unplanned hospital readmission in 2013, according to the findings of a recent study.

In their retrospective cohort study, the researchers examined admission and readmission data of patients with ESRD on hemodialysis in 2013 using the Nationwide Readmission Database. Using Clinical Classification Software, the researchers categorized admission diagnoses into clinically meaningfully categories and determined concordance of reasons for hospitalizations and readmissions. Predictors for at least 1 readmission were identified using logistic regression.
_____________________________________________________________________
RELATED CONTENT
Prior CV Events Increase Risk for ESRD in Type 2 Diabetes Patients
Quality of Sleep Could Significantly Increase Risk of End Stage Renal Disease
_____________________________________________________________________
Overall, 87,302 (22%) hospitalized patients experienced at least one 30-day unplanned hospital readmission after discharge. The characteristics of patients and hospitals with remissions compared with those without were statistically different, however the absolute differences were small. In addition, 80% of admissions had discordant primary reasons for initial hospitalization and readmission.

The highest readmission rate was for acute myocardial infarction (25%) and the lowest was for hypertension (20%). Depression (odds ratio (OR) 1.10), drug abuse (1.41), and discharge against medical advice (1.57) were associated with readmissions.

Surprisingly, the researchers found that 20% of all readmissions were associated with a group of high utilizers, which accounted for only 2% of the study population.

“In patients with ESRD on hemodialysis, nearly one quarter of admissions were followed by a 30-day unplanned readmission,” the researchers concluded. “Most readmissions were for primary diagnoses that were different from initial hospitalization. A small proportion of patients accounted for a disproportionate number of readmissions.”

—Melissa Weiss

Reference:

Chan L, Chauhan K, Poojary P, et al. National estimates of 30-day unplanned readmissions of patients on maintenance hemodialysis [published online before print September 28, 2017]. Clin J Am Soc Nephrol. doi:10.2215/CJN.08810817.