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. 2019 Jul 29;20(1):285.
doi: 10.1186/s12882-019-1473-0.

Long-term outcomes among Medicare patients readmitted in the first year of hemodialysis: a retrospective cohort study

Katherine H Ross  1 , Bernard G Jaar  2   3   4   5 , Janice P Lea  6 , Tahsin Masud  6 , Rachel E Patzer  1   6   7 , Laura C Plantinga  8   9
Affiliations

Long-term outcomes among Medicare patients readmitted in the first year of hemodialysis: a retrospective cohort study

Katherine H Ross et al. BMC Nephrol. .

Abstract

Background: Readmission within 30 days of hospital discharge is common and costly among end-stage renal disease (ESRD) patients. Little is known about long-term outcomes after readmission. We estimated the association between hospital admissions and readmissions in the first year of dialysis and outcomes in the second year.

Methods: Data on incident dialysis patients with Medicare coverage were obtained from the United States Renal Data System (USRDS). Readmission patterns were summarized as no admissions in the first year of dialysis (Admit-), at least one admission but no readmissions within 30 days (Admit+/Readmit-), and admissions with at least one readmission within 30 days (Admit+/Readmit+).We used Cox proportional hazards models to estimate the association between readmission pattern and mortality, hospitalization, and kidney transplantation, accounting for demographic and clinical covariates.

Results: Among the 128,593 Medicare ESRD patients included in the study, 18.5% were Admit+/Readmit+, 30.5% were Admit+/Readmit-, and 51.0% were Admit-. Readmit+/Admit+ patients had substantially higher long-term risk of mortality (HR = 3.32 (95% CI, 3.21-3.44)), hospitalization (HR = 4.46 (95% CI, 4.36-4.56)), and lower likelihood of kidney transplantation (HR = 0.52 (95% CI, 0.44-0.62)) compared to Admit- patients; these associations were stronger than those among Admit+/Readmit- patients.

Conclusions: Patients with readmissions in the first year of dialysis were at substantially higher risk of poor outcomes than either patients who had no admissions or patients who had hospital admissions but no readmissions. Identifying strategies to both prevent readmission and mitigate risk among patients who had a readmission may improve outcomes among this substantial, high-risk group of ESRD patients.

Keywords: Hemodialysis; Hospital readmissions; Kidney transplantation; Morbidity; Mortality.

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Conflict of interest statement

Two authors are affiliated with BMC Nephrology (Bernard Jaar, Section Editor; Laura Plantinga, Associate Editor). Neither had any role in the handling or peer review of this manuscript.

Figures

Fig. 1
Fig. 1
Flow diagram showing study sample selection among 2010–2013 incident U.S. hemodialysis patients
Fig. 2
Fig. 2
Timeline showing ascertainment of readmission pattern and outcomes in our cohort of 2010–2013 incident U.S. hemodialysis patients
Fig. 3
Fig. 3
Distributions of outcomes in the second year of dialysis treatment among 2010–2013 incident U.S. hemodialysis patients by readmission pattern in the first year of dialysis. Hospitalized = admitted at any point in year 2 but remaining alive and on dialysis during year 2
Fig 4
Fig 4
Cumulative mortality (a), hospitalization (b), and hospitalization involving intensive care unit (ICU) utilization (c) in second year of hemodialysis by readmission pattern in their first year of dialysis, among 2010–2013 incident U.S. hemodialysis patients. P < 0.001 by log-rank for all
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