Risks of Subsequent Hospitalization and Death in Patients with Kidney Disease

Daratha, Kenn B.; Short, Robert; Corbett, Cynthia F.; Ring, Michael E.; Alicic, Radica Z.; Choka, Randall; Tuttle, Katherine R.

doi:10.2215/cjn.05070511

Cited by 82 publications

(83 citation statements)

References 24 publications

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“…Hospitalizations are a burden for patients, caregivers, and the health care system. Admissions represent greater illness acuity and have been associated with higher mortality among adults undergoing chronic dialysis (4). The Centers for Medicare & Medicaid Services is considering adding a 30-day readmission measure to the ESRD Quality Incentive Program (5) and penalizing dialysis units with high readmission rates.…”

Section: Introductionmentioning

confidence: 99%

Readmission within 30 days of Hospital Discharge among Children Receiving Chronic Dialysis

Springel

Laskin

Furth

2014

Clinical Journal of the American Society of Nephrology

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Background and objectives The hospital admission rate for children receiving chronic dialysis has been increasing over the last decade. Approximately one third of patients with ESRD age 0-19 years are readmitted to the hospital within 30 days of discharge. The objective of this study was to examine hospital readmissions among a cohort of children receiving chronic dialysis to identify factors associated with higher rates of 30-day readmission.Design, settings, participants, & measurements A retrospective cohort of index admissions was developed among chronic dialysis patients age 3 months to 17 years at free-standing children's hospitals reporting information to the Pediatric Hospital Information System between January 2006 and November 30, 2010, and followed until December 31, 2010. The primary outcome was any-cause 30-day readmission, and the secondary outcome was 30-day readmission for a cause similar to that of the index hospitalization.Results In this cohort, 25% of hospital admissions were followed by a readmission within 30 days. Children older than 2 years of age had a lower odds of readmission (odds ratio [OR], 0.6; 95% confidence interval [95% CI], 0.5 to 0.8). Those receiving hemodialysis had a higher risk of readmission (OR, 1.2; 95% CI, 1.0 to 1.4), and admissions .14 days were also more likely to be followed by a readmission (OR, 1.5; 95% CI, 1.1 to 2.0). Approximately 50% of the readmissions were for a similar diagnosis as the index admission; however, the specific admitting diagnosis was not associated with readmission.Conclusions A significant number of admissions among children receiving long-term dialysis are followed by readmission within 30 days. Further investigation is required to reduce the high rate of readmissions in these children.

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Section: Introductionmentioning

confidence: 99%

Readmission within 30 days of Hospital Discharge among Children Receiving Chronic Dialysis

Springel

Laskin

Furth

2014

Clinical Journal of the American Society of Nephrology

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“…Comorbidity variables based on the index and previous hospitalizations (past 12 months) were determined by a set of 30 comprehensive definitions using the Elixhauser method [25]. This method is a well-known and well-validated method of controlling for comorbidities in investigations that utilize administrative data [1,26,27,28]. Specific to the current investigation, it is important to note that key comorbidities such as diabetes and hypertension were controlled for in the study analyses.…”

Section: Methodsmentioning

confidence: 99%

“…Patients with chronic kidney disease (CKD) are at a substantially increased risk of repeat hospitalizations, including admissions resulting in death [1,2]. CKD is a known risk factor for all-cause mortality and cardiovascular disease [2,3].…”

Section: Introductionmentioning

confidence: 99%

Association of Co-Occurring Serious Mental Illness with Emergency Hospitalization in People with Chronic Kidney Disease

McPherson¹,

Barbosa‐Leiker²,

Daratha

et al. 2014

Am J Nephrol

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Background/Aims: Chronic kidney disease (CKD) and serious mental illness (SMI) are both associated with an increased risk for repeated hospitalization. The objective of this study was to determine if co-occurring SMI exacerbates the risk for subsequent hospitalization, particularly through the emergency department (ED), among people with CKD. Methods: People hospitalized in Washington State from April 2006 to December 2008 were separated into cohorts with diagnoses of CKD (n = 31,166), SMI (defined by schizophrenia and/or mood disorder; n = 20,167) or CKD with co-occurring SMI (n = 717), and a reference cohort without either diagnosis (n = 548,532). Main outcomes were rehospitalization for condition(s) other than mental illness: (1) through the ED; (2) any admission, and (3) admission resulting in death. Cox regression was used to analyze time to main outcomes controlling for prespecified covariates associated with rehospitalization. Results: The risk of rehospitalization via the ED was increased for people with CKD (hazard ratio, HR = 1.24, 95% confidence interval, CI = 1.21-1.28, p < 0.001) and co-occurring SMI (HR = 1.33, 95% CI = 1.29-1.38, p < 0.001) cohorts, but was significantly greater in the combined cohort (HR = 1.55, 95% CI = 1.40-1.73, p < 0.001). Similarly, the risk of any rehospitalization was increased for CKD (HR = 1.21, 95% CI = 1.17-1.25, p < 0.001) and co-occurring SMI (HR = 1.14, 95% CI = 1.11-1.17, p < 0.001) cohorts, while a significantly greater risk was observed for the combined cohort (HR = 1.36, 95% CI = 1.24-1.48, p < 0.001). The risk of rehospitalization resulting in death was not significantly increased in the combined cohort. Conclusion: In people with CKD, co-occurring SMI increased the risk of experiencing rehospitalization, particularly through the ED. Studies of strategies to address SMI in the CKD population are needed to mitigate the risk of repeat hospital admissions.

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“…For example, risks of adverse outcomes are extraordinarily high when people with CKD move from an inpatient hospitalization to the outpatient setting. The CKD population has more comorbid conditions, is hospitalized more often and for longer lengths of stay, and incurs greater health care costs than patients with other chronic diseases (46)(47)(48). Moreover, patients with CKD are less likely to receive evidence-based therapies when hospitalized for serious illnesses, such as myocardial infarction, and commonly have complex drug regimens and adverse events that contribute to poor outcomes (49,50).…”

Section: Patient Safety and Transitions In Carementioning

confidence: 99%

Type 2 Translational Research for CKD

Tuot

Corbett

Setter

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryStrategies to effectively treat people with CKD have been identified by conventional clinical research. Despite this evidence, awareness, screening, detection, diagnosis, risk factor control, treatment, and outcomes remain substandard. Translating clinical evidence into actionable measures that reduce the burden of CKD is a pressing need. Expansion from a "bench-to-bedside" paradigm (conventional type 1 translation) to research that encompasses "clinic and community" is the core concept of type 2 translation. Specifically, this is the discipline of identifying factors and using strategies that lead to adoption, maintenance, and sustainability of science-based interventions in practice. This review identifies key elements of type 2 translational research and highlights the current scope of this type of research for CKD. For type 2 translation to achieve the goals of providing high-quality care and better health outcomes, key facilitators (e.g., theory-based frameworks, adaptable interventions, and inclusion of sustainability and evaluation metrics) and essential elements (e.g., multidisciplinary team care, health information technology, and stakeholder engagement) must be integrated. The National Institute of Diabetes and Digestive and Kidney Diseases recently funded five proposals that aim to improve outcomes for people with CKD, focusing on diverse components of the healthcare continuum: patient safety and transitions; delivery of highquality, evidence-based CKD care; and elimination of disparities. The need for type 2 translational research in CKD is urgent because of preventable human suffering and unsustainable costs of providing care. Focus on the theory, framework, and approaches we have suggested may help us meet that challenge.

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Risks of Subsequent Hospitalization and Death in Patients with Kidney Disease

Cited by 82 publications

References 24 publications

Readmission within 30 days of Hospital Discharge among Children Receiving Chronic Dialysis

Readmission within 30 days of Hospital Discharge among Children Receiving Chronic Dialysis

Association of Co-Occurring Serious Mental Illness with Emergency Hospitalization in People with Chronic Kidney Disease

Type 2 Translational Research for CKD

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