National Estimates of 30-Day Unplanned Readmissions of Patients on Maintenance Hemodialysis

Patients on hemodialysis have high 30-day unplanned readmission rates. Using a national all-payer administrative database, we describe the epidemiology of 30-day unplanned readmissions in patients on hemodialysis, determine concordance of reasons for initial admission and readmission, and identify p...

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Bibliographic Details
Published in:Clinical journal of the American Society of Nephrology 2017-10, Vol.12 (10), p.1652-1662
Main Authors: Chan, Lili, Chauhan, Kinsuk, Poojary, Priti, Saha, Aparna, Hammer, Elizabeth, Vassalotti, Joseph A, Jubelt, Lindsay, Ferket, Bart, Coca, Steven G, Nadkarni, Girish N
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Chi-Square Distribution
Comorbidity
Databases, Factual
Female
Humans
Kidney Failure, Chronic - diagnosis
Kidney Failure, Chronic - epidemiology
Kidney Failure, Chronic - therapy
Logistic Models
Male
Middle Aged
Odds Ratio
Original
Patient Readmission
Renal Dialysis - adverse effects
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
United States - epidemiology
Young Adult
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Summary:Patients on hemodialysis have high 30-day unplanned readmission rates. Using a national all-payer administrative database, we describe the epidemiology of 30-day unplanned readmissions in patients on hemodialysis, determine concordance of reasons for initial admission and readmission, and identify predictors for readmission. This is a retrospective cohort study using the Nationwide Readmission Database from the year 2013 to identify index admissions and readmission in patients with ESRD on hemodialysis. The Clinical Classification Software was used to categorize admission diagnosis into mutually exclusive clinically meaningful categories and determine concordance of reasons for admission on index hospitalizations and readmissions. Survey logistic regression was used to identify predictors of at least one readmission. During 2013, there were 87,302 (22%) index admissions with at least one 30-day unplanned readmission. Although patient and hospital characteristics were statistically different between those with and without readmissions, there were small absolute differences. The highest readmission rate was for acute myocardial infarction (25%), whereas the lowest readmission rate was for hypertension (20%). The primary reasons for initial hospitalization and subsequent 30-day readmission were discordant in 80% of admissions. Comorbidities that were associated with readmissions included depression (odds ratio, 1.10; 95% confidence interval [95% CI], 1.05 to 1.15;
ISSN:1555-9041
1555-905X
DOI:10.2215/CJN.02600317