Burden and Correlates of Hospital Readmissions among U.S. Peritoneal Dialysis Patients

Abstract

Background Hospital readmissions are common among in- center hemodialysis patients, but little is known about read-missions among peritoneal dialysis (PD) patients. Using national administrative data, we aimed to examine the burden and correlates of hospital readmissions among U.S. PD patients. Methods Among 10,505 adult U.S. PD patients with an index admission (first admission after 120 days on dialysis) between 31 January 2011 and 30 November 2014, readmissions were defined as new hospital admissions within 30 days of index discharge. Multivariable logistic regression was used to obtain adjusted odds ratios (ORs) for readmission. Results Overall, 26.8% of index admissions were followed by a readmission. Readmitted patients were more likely to have congestive heart failure (31.0% vs 25.4%; p < 0.001) and peripheral arterial disease (11.6% vs 8.6%; p < 0.001) and had longer index admission length of stay (median = 4 vs 3 days; p < 0.001) than those who were not; age, sex, and race did not differ by readmission status. After adjustment for patient and index admission characteristics, longer length of stay (≥ 4 vs < 4 days, OR = 1.48, 95% confidence interval [CI] 1.35 – 1.62), peripheral arterial disease (OR = 1.31, 95% CI 1.16 – 1.57), congestive heart failure (OR = 1.25, 95% CI 1.13 – 1.39), and ischemic heart disease (OR = 1.12, 95% CI 1.01 – 1.24) were associated with higher likelihood of readmission; index admission due to peritonitis vs other causes was associated with lower likelihood of readmission (OR = 0.80, 95% CI 0.70 – 0.92). Conclusions Our results suggest that, particularly in the absence of a PD-related cause of hospitalization such as peritonitis, PD patients may be at high risk for readmission and may benefit from closer post-discharge monitoring.

Strategies to Reduce Rehospitalization in Patients with CKD and Kidney Failure

“…Risk factors for readmission included older age, female sex, diagnosis of liver disease, depression or peripheral vascular disease, and longer length of stay (.5 days) during index admission. Another report of 10,505 patients on PD with index admission during 2011-2014 showed a higher rate of readmission at 29% compared with prior studies (44). The authors identified diagnoses of congestive heart failure and peripheral vascular disease to be independent risk factors, along with hospital stay $4 days.…”

Association of cardiovascular disease with 30-day hospital readmission in Chinese patients receiving maintenance dialysis

“…However, the NRD only contains data from community hospitals, and information on patients whose initial admission occurred in other states is not captured by this database; therefore, the rate of hospital readmission in HD patients may be underestimated. Data from the USRDS suggests that IHD, cerebrovascular disease, and HF are associated with hospital readmission in PD patients (12). A recent study indicated that CVDs, including arteriosclerotic heart disease, congestive HF, and transient ischemic attack, could predict 30-day hospital readmission among patients receiving dialysis (14).…”

“…A recent study indicated that CVDs, including arteriosclerotic heart disease, congestive HF, and transient ischemic attack, could predict 30-day hospital readmission among patients receiving dialysis (14). These studies tended to focus on readmissions among patients receiving a single type (HD or PD) of continuous renal replacement therapy (12,14). In their study, Wetmore et al investigated hospital readmission, focusing on patients frequently hospitalized for CVD (14).…”

“…Cardiovascular disease (CVD), a leading cause of hospitalization and death, is common among patients receiving maintenance dialysis (5,10). Accumulating evidence on dialysis patients suggests that CVD increases the risk of hospital readmission (11)(12)(13)(14). Previous studies on HD patients have suggested that heart failure (HF) increases the risk of hospital readmission (11).…”

“…Previous studies on HD patients have suggested that heart failure (HF) increases the risk of hospital readmission (11). Studies have shown that ischemic heart disease (IHD) and HF are associated with higher rates of hospital readmission among patients receiving peritoneal dialysis (PD) (12,13). Another study found that hospital readmission rates were higher among HD and PD patients with CVD (14).…”