Analysis of factors affecting rehospitalization of patients with chronic kidney disease after educational hospitalization

Abstract

BackgroundChronic kidney disease (CKD) is associated with a high risk of cardiovascular disease complications. Therefore, medical institutions conduct educational hospitalization for early treatment and education of CKD patients. However, patients who have been discharged after achieving educational targets can end up showing poor symptoms at home. There also have been several cases of rehospitalization or disease aggravation. In this study, we analyzed rehospitalized patients who were discharged from the hospital after CKD educational hospitalization and investigated the purpose of analyzing rehospitalization factors.Materials and methodsThis was an observational case-control study conducted at Yokosuka Kyousai Hospital. We performed univariate analysis using patient background features and laboratory data between a rehospitalization group and a no-rehospitalization group. Next, we performed multiple logistic regression analysis using the results of the univariate analysis.ResultsFrom the results of this study, we identified independent risk factors, such as serum albumin level, heart-failure complications, and estimated glomerular filtration rate (eGFR). Moreover, the serum Alb level was identified as the most important risk factor for rehospitalization. Therefore, we considered that it is important to live a life that makes it possible to maintain CKD stage G3b for a long time after discharge, because the cutoff level of eGFR is 31 mL/minute/1.73 m2.ConclusionWe believe that it is important to educate patients, their families, and medical staff on the importance of early detection and treatment, and we consider that this approach is important to inclusively protect the kidney.

Early rehospitalization after initial chronic kidney disease educational hospitalization relates with a multidisciplinary medical team

“…Alb and eGFR were not significant in univariate analysis. However, these factors were significantly different between rehospitalization group and non-rehospitalization group in previous study [4]. In addition, decrease in the serum Alb level leads to malnutrition and sthenic inflammatory response and the effects of enhancing the renin–angiotensin system due to the progression of renal dysfunction, blood pressure elevation due to fluid retention, and aggravation of arteriosclerosis are associated with CVD.…”

“…The patients discharged within March 2011 to October 2012 were subjected to the analysis in our previous reports [4]. We classified patients who had been rehospitalized within 30 days after discharge from CKD educational hospitalization as early rehospitalization group according to previous report [5].…”

“…We chose significant factors as independent variables on the basis of univariate analysis results. We chose factors (eGFR, Alb) that were reportedly associated with the progression of CKD [4, 6, 7] and factors whose p values were small (i.e., instruction by physicians, pharmacists, and dietitians). Alb and eGFR were not significant in univariate analysis.…”

“…However, some patients who have achieved their educational targets tend to have poor compliance at home after discharge from the hospital within one year, resulting in rehospitalization after discharge. We examined the factor for rehospitalization within one year after CKD educational hospitalization in previous study [4]. We revealed that rehospitalization within one year after CKD educational hospitalization was not associated with the number of instructions by pharmacists or dieticians but with Alb < 3.5 g/dL, heart failure complications, and eGFR of < 31 mL/min/1.73 m 2 .…”

“…However, some patients rehospitalized early after discharge were included among rehospitalized patients. We considered that factors other than those revealed in previous study [4] may be involved in these patients. However, in our previous study, we could not analyze the factors for early rehospitalization because the number of patients with early rehospitalization was small.…”