Readmissions Following a Hospitalization for Cardiovascular Events in Dialysis Patients: A Retrospective Cohort Study

Abstract

BackgroundHospitalization for cardiovascular disease (CVD) is common among patients receiving maintenance dialysis, but patterns of readmissions following cardiovascular events are underexplored.Methods and ResultsIn this retrospective analysis of prevalent, Medicare‐eligible patients receiving dialysis in 2012–2013, all live‐discharge hospitalizations attributed to CVD were ascertained. Rates of all‐cause, CVD‐related, and non–CVD‐related readmissions and death in the ensuing 10 and 30 days were calculated. Multinomial logistic modeling was used to assess the relationship between potential explanatory factors and outcomes of interest. Among 142 210 analyzed hospitalizations, mean age at time of index CVD hospitalization was 64.9±14.1 years; 50.4% of index hospitalizations were for women, and 41.4% were for white patients. Fully 15.6% and 34.2% of CVD hospitalizations resulted in readmission within 10 and 30 days, respectively; less than half of readmissions were CVD related (42.5%, 10 days; 43.1%, 30 days). Death within 30 days, regardless of readmission, occurred after 4.5% of index hospitalizations; 51.2% were attributed to CVD. Compared with ages 65 to 69 years, younger age tended to be associated with increased readmission risk (adjusted relative risk for ages 18–44 years: 1.55; 95% confidence interval, 1.48–1.63). Readmission risk did not differ between white and black patients, but risk of death without readmission was markedly lower for black patients (relative risk: 0.60; 95% confidence interval, 0.55–0.67).ConclusionsRoughly 1 in 3 CVD hospitalizations resulted in 30‐day readmission; nearly 1 in 20 was followed by death within 30 days. Risk of death without readmission was higher for white than black patients, despite no difference in risk of readmission.

Risk factors and outcomes of cardiovascular disease readmission within the first year after dialysis in peritoneal dialysis patients

“…Moreover, previous studies have demonstrated that CVD is a common cause of readmission in dialysis patients. Indeed, CVD accounted for 40–50% of readmissions in HD patients [ 9 , 10 , 22 ]. Regarding PD, CVD readmission was responsible for nearly 25% of all readmissions within 120 days after dialysis; additionally, 40.8% of these patients tended to have another CVD readmission within the following 30 days [ 8 ].…”

“…Furthermore, studies investigating the prevalence of readmissions in different dialysis modalities have presented conflicting results. Some studies showed that PD patients were at higher risks of all-cause readmission than HD patients [ 6 ], but some studies yielded a similar readmission rate [ 14 , 22 ]. However, Ross et al.…”

Staphylococcus aureus colonization in hemodialysis patients: a prospective 25 months observational study

“…Indeed, the main causes of death in our hemodialysis study population were bloodstream infections by pathogens other than S. aureus (73%), followed by cardiovascular events (14%), and various causes (13%). Previous studies report that the main causes of death are comorbidities that occur alongside with or result from renal insufficiency [24]: cardiovascular events (40%), bloodstream infections (30%) and sudden deaths of patients at home with unknown cause (25%) [29, 30], the latter often again being attributed to cardiovascular events [28]. How S. aureus carriage could influence the overall mortality due to non- S. aureus infections and other, non-infectious diseases remains to be clarified.…”

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

“…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).…”