Emergency Department Use and Hospital Admissions Among Patients With End-Stage Renal Disease in the United States

Abstract

Patients with end-stage renal disease (ESRD) have the highest risk for hospitalization among those with chronic medical conditions, including heart failure, pulmonary disease, or cancer. 1 However, to our knowledge, no study has examined use of the emergency department (ED) among the national Medicare population with ESRD. We sought to describe ED visits and hospitalizations through the ED and to determine the sociodemographic and clinical characteristics of patients with ESRD who use ED services in the United States.

Emergency department use among kidney transplant recipients in the United States

“…Patients with more comorbidities such as diabetes, cerebrovascular disease, peripheral vascular disease, and chronic obstructive pulmonary disease have higher rates of ED visits in the first year posttransplantation. Perhaps not surprisingly, the sociodemographic factors associated with barriers to transplantation, including female sex, public insurance, and multiple comorbidities, are similar to the factors that we found were associated with ED use in the KTx patient population …”

“…Thus, the overall study population included 132 725 KTx recipients. We also examined a comparison population of incident patients with ESRD from 2005 to 2013 (n = 769 228) as previously described …”

“…Patients with end‐stage renal disease (ESRD) compose only 0.9% of Medicare enrollment, yet account for 7.1% of total Medicare expenditures . Patients with ESRD use the ED at a 6‐fold higher rate than the general population; however, most prior studies excluded kidney transplant (KTx) patients, who represent a growing proportion (22.8%) of prevalent patients with ESRD . Optimal care of KTx recipients requires a coordinated treatment and management approach to guide transitions of care from the inpatient to outpatient care setting.…”

Associations among race, residential segregation, community income, and emergency department use by adults with end‐stage renal disease

“…Individuals with end‐stage renal disease (ESRD) who receive maintenance dialysis as a renal replacement therapy are a high‐need, high‐risk vulnerable population who utilize ED services at significantly higher rates than the general population. In the U.S., adult dialysis patients experience ED utilization rates that are six times higher than the general population and four times higher than U.S. Medicare beneficiaries without ESRD (Lovasik et al, ). Moreover, the rates of ED visits within this population are on the rise.…”

Bandages will not fix a fractured system of chronic kidney disease care: Why the Dialysis PATIENTS Demonstration Act cannot be supported by the transplant community

“…The inclusion of a few minimal standards for transplant is unlikely to mitigate the strong financial incentive to maintain patients on dialysis. It is foreseeable the patients enrolled and maintained in the DPDA will be phenotypically at “low risk” for high health care use and will contribute significantly to the denominator of the cost per member ratio that drives provider profit in the model proposed by the DPDA. Since pre‐ESRD and post‐transplant patients are excluded, there is no accountability or potential for cost savings for improving the care of these patients (ie, through preemptive transplant or improved transplant survival), and there is a passive disincentive to promote transplant.…”