Both high CRP and low albumin, measured in CKD stages 3 and 4, are independent risk factors for all-cause mortality. High CRP, but not serum albumin, is a risk factor for cardiovascular mortality. These results suggest that high CRP and hypoalbuminemia provide prognostic information independent of each other in CKD.

Adiponectin is presumed to possess antiatherogenic and cardioprotective properties. Limited data exist on the relationship between adiponectin and mortality in the earlier stages of chronic kidney disease. The Modification of Diet in Renal Disease study was a randomized, controlled trial that was conducted between 1989 and 1993. Adiponectin was measured in frozen samples that were obtained at baseline (N ‫؍‬ 820). Survival status and cause of death, up to December 31, 2000, were obtained from the National Death Index. Multivariable Cox models were used to examine the relationship of adiponectin with all-cause and cardiovascular mortality. Mean ؎ SD age was 52 ؎ 12 yr, and mean ؎ SD glomerular filtration rate (GFR) rate was 33 ؎ 12 ml/min per 1.73 m 2 . Eighty-five percent of participants were white, and 60% were male. Mean ؎ SD adiponectin was 12.8 ؎ 8.0 g/ml. Triglycerides, insulin resistance, glucose, body mass index, GFR, C-reactive protein, and albumin were inversely related and proteinuria and HDL cholesterol were directly related to adiponectin. During the 10-year follow-up period, 201 (25%) participants died of any cause, and 122 (15%) from cardiovascular disease. In multivariable adjusted Cox models, a 1-g/ml increase in adiponectin was associated with a 3% (hazard ratio 1.03; 95% confidence interval 1.01 to 1.05; P ‫؍‬ 0.02) increased risk for all-cause and 6% (hazard ratio 1.06; 95% confidence interval 1.03 to 1.09; P < 0.001) increased risk for cardiovascular mortality. High, rather than low, adiponectin is associated with increased mortality in this cohort of patients with chronic kidney disease stages 3 to 4. Further studies are necessary to confirm this association and to elucidate the underlying mechanisms. A diponectin is an adipocyte-derived peptide that may possess antiatherogenic properties (1,2). Obesity (3), coronary artery disease (4 -6), and diabetes (7) are characterized by low adiponectin levels, suggesting an inverse association with cardiovascular disease (CVD) risk. Whereas prospective studies in diabetic and nondiabetic men have demonstrated an inverse relationship between adiponectin levels and risk for CVD events (5,6), this association was not found in women (8) and in a population-based cohort of American Indians (9). On the contrary, in a few studies, high rather than low adiponectin levels were associated with adverse outcomes in patients with type 1 diabetes (10,11) and heart failure (12).Kidney function is an important determinant of circulating levels of adiponectin (13,14), and levels of this protein are markedly elevated in kidney failure (15). Data on the relationship between adiponectin and outcomes in patients with chronic kidney disease (CKD) are sparse. Low adiponectin levels were associated with increased risk for CVD events in one study of hemodialysis patients (15). Similarly, there was an inverse correlation between adiponectin levels and incident CVD in univariate analyses in a small cohort of patients in the earlier stages of CKD (13). Using data from the random...

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Hospitals with the highest readmission rates for high-cost conditions may be targeted for payment penalties. The primary aim of this study was to determine clinical predictors of 30-day readmission after discharge for patients undergoing orthotopic liver transplantation (OLT) at the University of Washington from January 2003 to October 2010. Secondary aims included the determination of predictors of institutional care after OLT and differences in survival between patients requiring 30-day readmission and patients not requiring 30-day readmission. Sixty-five of 766 discharged OLT patients (8.6%) required institutional care on discharge; 318 of the 701 remaining patients (45%) were readmitted within 30 days. The predictors of readmission included hospitalization within the 90 days before OLT [29.6% versus 18.4%, relative risk (RR) ¼ 1.33, P ¼ 0.04], pre-OLT portal vein thrombosis (7.9% versus 4.4%, RR ¼ 1.76, P ¼ 0.01), a creatinine level > 1.9 mg/dL (23.9% versus 11.5%, RR ¼ 2.1, P 0.01), an albumin level < 2.6 mg/dL (51.9% versus 37.6%, RR ¼ 1.57, P < 0.01), postoperative complications (38.7% versus 30.2%, RR ¼ 1.31, P ¼ 0.04), and a high school education or less (14.5% versus 10%, RR ¼ 1.41, P ¼ 0.04). One year after OLT, decreased survival was found for patients requiring 30-day readmission versus patients not requiring readmission (88.2% versus 95.6%, P < 0.05). In conclusion, this study has identified patients at high risk of readmission who may benefit from medical optimization. Liver Transpl 18:1037-1045, 2012. See Editorial on Page 1007Hospital readmissions are a leading topic of health care policy and practice reform, and they are increasingly being viewed as a clinical outcome measure. With an estimated cost to Medicare of 17.4 billion dollars in 2004, hospital readmissions are a large target for cost reduction. The Medicare Affordable Care Act of 2010 directs the Centers for Medicaid and Medicare Services to track hospital readmission rates for certain high-cost conditions and implement a payment penalty for hospitals with the highest readmission rates. 1 A readmission is defined as a return to the same hospital or a different hospital for the same condition within a time frame to be specified by the Secretary of Health and Human Services. The use of readmission rates as a measure of quality has implications that extend beyond financial concerns and could potentially affect referral patterns, medical education, and credentialing. Several measures that aim to decrease readmission rates may result in an increased initial hospital length of stay (LOS), and the cost-effectiveness of this strategy remains unclear.Orthotopic liver transplantation (OLT) is an expensive procedure with estimated US annual costs greater than 3 billion dollars and a per-patient cost greater than half a million dollars for the first year after OLT. 2 The postdischarge requirements of some OLT recipients for inpatient rehabilitation and skilled nursing facilities further increase expenditures and the utilization of resources. At t...