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Patient Issues Author: Staff Editor Last Updated: Sep 29, 2017 - 1:31:41 PM



Why Are Many Dialysis Patients Readmitted to the Hospital Soon after Discharge?

By Staff Editor
Sep 29, 2017 - 10:15:03 AM



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(HealthNewsDigest.com) - A new analysis found that nearly one-quarter of dialysis patients who are admitted to the hospital are readmitted soon after discharge, often for a diagnosis that is different than the one that led to the initial hospitalization. The analysis, which appears in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), also identified certain patient characteristics linked to hospital readmissions.

More than half a million people in the United States receive treatment for kidney failure, mostly through hemodialysis. On average, hemodialysis patients are admitted to the hospital nearly twice a year, and they have double the 30-day readmission rate as patients without kidney dysfunction. In 2017, the Centers for Medicare and Medicaid Services began penalizing outpatient dialysis units for excessive readmissions. Despite these efforts, there is a lack of information regarding characteristics and predictors of readmission.

To investigate, a team led by Girish Nadkarni, MD, MPH and Lili Chan, MD, MS (Icahn School of Medicine at Mount Sinai) set out to determine the nationwide readmission rate in dialysis patients and to examine reasons for initial admissions and readmissions. When the researchers analyzed 2013 data from the Nationwide Readmission Database, they found 390,627 initial hospitalizations of hemodialysis patients, and 22% of these initial hospitalizations were followed by an unplanned readmission within 30 days. Readmission rates were similar across the top 10 initial admission diagnoses, and only 20% of readmissions were for the same diagnosis as the initial admission.

“Regardless of what patients initially were admitted for, they had similar readmission rates. This along with the low concordance suggests that we need to focus on the patient as a whole rather than their admission diagnoses,” said Dr. Chan.

The investigators also found that patient characteristics that were associated with a high likelihood of readmission included female gender, younger age, depression, liver disease, congestive heart failure, and drug abuse. Importantly, only a small proportion (2%) of all patients accounted for 20% of all readmissions.

“To reduce readmissions in dialysis patients, perhaps a good starting place would be to institute interventions targeted at high utilizers and create a validated risk score incorporating likely risk factors,” said Dr. Nadkarni.

In an accompanying editorial, Magdalene Assimon, PharmD, MS and Jennifer Flythe, MD, MPH (UNC School of Medicine) noted that there is surprisingly little published data evaluating interventions designed to reduce readmissions and stressed “the need for innovative, integrative data analytics in readmission risk modeling and a greater emphasis on testing and refining readmission prevention strategies.” They also quoted the American philosopher John Dewey, who said, “A problem well put, is half-solved.” “The problem of 30-day hospital readmissions among individuals receiving maintenance hemodialysis is increasingly ‘well put.’ The next step is to see that the problem is also well-solved,” they wrote.

Study co-authors include Kinsuk Chauhan MD, Priti Poojary MD, Aparna Saha MD, Elizabeth Hammer, MD, Joseph Vassalotti, MD, Lindsay Jubelt, MD, Bart Ferket MD, PhD, and Steven Coca DO, MS.

Disclosures: L.C. is supported in part by the National Institutes of Health. B.F is supported in part by American Heart Association. G.N. is supported in part by the National Institutes of Health.

The article, entitled “National Estimates of Thirty Day Unplanned Readmissions of Patients on Maintenance Hemodialysis,” will appear online at http://cjasn.asnjournals.org/ on September 28, 2017, doi: 10.2215/CJN.02600317.

The editorial, entitled “Thirty-Day Hospital Readmissions in the Hemodialysis Population: A Problem Well Put, But Half-Solved,” will appear online at http://cjasn.asnjournals.org/ on September 28, 2017.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has nearly 17,000 members representing 112 countries. For more information, please visit www.asn-online.org or contact the society at 202-640-4660.

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