Hospital Readmission among New Dialysis Patients Associated with Young Age and Poor Functional Status

LaTonya Hickson, Bjoerg (Bjorg) Thorsteinsdottir, Priya Ramar, Megan S. Reinalda, Cynthia Crowson, Amy W. Williams, Robert C. Albright, Macaulay A. Onuigbo, Andrew D Rule, Nilay D Shah

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background/Aims: Over one-third of hospital discharges among dialysis patients are followed by 30-day readmission. The first year after dialysis start is a high-risk time frame. We examined the rate, causes, timing, and predictors of 30-day readmissions among adult, incident dialysis patients. Methods: Hospital readmissions were assessed from the 91st day to the 15th month after the initiation of dialysis using a Mayo Clinic registry linkage to United States Renal Data System claims during the period January 2001–December 2010. Results: Among 1,727 patients with ≥1 hospitalization, 532 (31%) had ≥1, and 261 (15%) had ≥2 readmissions. Readmission rate was 1.1% per person-day post-discharge, and the highest rates (2.5% per person-day) occurred ≤5 days after index admission. The overall cumulative readmission rate was 33.8% at day 30. Common readmission diagnoses included cardiac issues (22%), vascular disorders (19%), and infection (13%). Similar-cause readmissions to index hospitalization were more common during days 0–14 post-discharge than days 15–30 (37.5 vs. 22.9%; p = 0.004). Younger age at dialysis initiation, inability to transfer/ambulate, serum creatinine ≤5.3 mg/dL, higher number of previous hospitalizations, and longer duration on dialysis were associated with higher readmission rates in multivariable analyses. Patients aged 18–39 were few (8.3%) but comprised 17.7% of “high-readmission” users such that a 30-year-old patient had an 87% chance of being readmitted within 30 days of any hospital discharge, whereas an 80-year-old patient had a 25% chance. Conclusions: Overall, 30-day readmissions are common within the first year of dialysis start. The first 10-day period after discharge, young patients, and those with poor functional status represent key areas for targeted interventions to reduce readmissions.

Original languageEnglish (US)
JournalNephron
DOIs
StateAccepted/In press - Jan 9 2018

Fingerprint

Patient Readmission
Dialysis
Hospitalization
Patient Discharge
Information Systems
Blood Vessels
Registries
Creatinine
Kidney
Infection
Serum

Keywords

  • Cardiovascular disease
  • Death
  • Heart failure
  • Hemodialysis
  • Hospitalization
  • Mortality
  • Youth

ASJC Scopus subject areas

  • Physiology
  • Nephrology
  • Urology
  • Physiology (medical)

Cite this

Hospital Readmission among New Dialysis Patients Associated with Young Age and Poor Functional Status. / Hickson, LaTonya; Thorsteinsdottir, Bjoerg (Bjorg); Ramar, Priya; Reinalda, Megan S.; Crowson, Cynthia; Williams, Amy W.; Albright, Robert C.; Onuigbo, Macaulay A.; Rule, Andrew D; Shah, Nilay D.

In: Nephron, 09.01.2018.

Research output: Contribution to journalArticle

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title = "Hospital Readmission among New Dialysis Patients Associated with Young Age and Poor Functional Status",
abstract = "Background/Aims: Over one-third of hospital discharges among dialysis patients are followed by 30-day readmission. The first year after dialysis start is a high-risk time frame. We examined the rate, causes, timing, and predictors of 30-day readmissions among adult, incident dialysis patients. Methods: Hospital readmissions were assessed from the 91st day to the 15th month after the initiation of dialysis using a Mayo Clinic registry linkage to United States Renal Data System claims during the period January 2001–December 2010. Results: Among 1,727 patients with ≥1 hospitalization, 532 (31{\%}) had ≥1, and 261 (15{\%}) had ≥2 readmissions. Readmission rate was 1.1{\%} per person-day post-discharge, and the highest rates (2.5{\%} per person-day) occurred ≤5 days after index admission. The overall cumulative readmission rate was 33.8{\%} at day 30. Common readmission diagnoses included cardiac issues (22{\%}), vascular disorders (19{\%}), and infection (13{\%}). Similar-cause readmissions to index hospitalization were more common during days 0–14 post-discharge than days 15–30 (37.5 vs. 22.9{\%}; p = 0.004). Younger age at dialysis initiation, inability to transfer/ambulate, serum creatinine ≤5.3 mg/dL, higher number of previous hospitalizations, and longer duration on dialysis were associated with higher readmission rates in multivariable analyses. Patients aged 18–39 were few (8.3{\%}) but comprised 17.7{\%} of “high-readmission” users such that a 30-year-old patient had an 87{\%} chance of being readmitted within 30 days of any hospital discharge, whereas an 80-year-old patient had a 25{\%} chance. Conclusions: Overall, 30-day readmissions are common within the first year of dialysis start. The first 10-day period after discharge, young patients, and those with poor functional status represent key areas for targeted interventions to reduce readmissions.",
keywords = "Cardiovascular disease, Death, Heart failure, Hemodialysis, Hospitalization, Mortality, Youth",
author = "LaTonya Hickson and Thorsteinsdottir, {Bjoerg (Bjorg)} and Priya Ramar and Reinalda, {Megan S.} and Cynthia Crowson and Williams, {Amy W.} and Albright, {Robert C.} and Onuigbo, {Macaulay A.} and Rule, {Andrew D} and Shah, {Nilay D}",
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AU - Hickson, LaTonya

AU - Thorsteinsdottir, Bjoerg (Bjorg)

AU - Ramar, Priya

AU - Reinalda, Megan S.

AU - Crowson, Cynthia

AU - Williams, Amy W.

AU - Albright, Robert C.

AU - Onuigbo, Macaulay A.

AU - Rule, Andrew D

AU - Shah, Nilay D

PY - 2018/1/9

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N2 - Background/Aims: Over one-third of hospital discharges among dialysis patients are followed by 30-day readmission. The first year after dialysis start is a high-risk time frame. We examined the rate, causes, timing, and predictors of 30-day readmissions among adult, incident dialysis patients. Methods: Hospital readmissions were assessed from the 91st day to the 15th month after the initiation of dialysis using a Mayo Clinic registry linkage to United States Renal Data System claims during the period January 2001–December 2010. Results: Among 1,727 patients with ≥1 hospitalization, 532 (31%) had ≥1, and 261 (15%) had ≥2 readmissions. Readmission rate was 1.1% per person-day post-discharge, and the highest rates (2.5% per person-day) occurred ≤5 days after index admission. The overall cumulative readmission rate was 33.8% at day 30. Common readmission diagnoses included cardiac issues (22%), vascular disorders (19%), and infection (13%). Similar-cause readmissions to index hospitalization were more common during days 0–14 post-discharge than days 15–30 (37.5 vs. 22.9%; p = 0.004). Younger age at dialysis initiation, inability to transfer/ambulate, serum creatinine ≤5.3 mg/dL, higher number of previous hospitalizations, and longer duration on dialysis were associated with higher readmission rates in multivariable analyses. Patients aged 18–39 were few (8.3%) but comprised 17.7% of “high-readmission” users such that a 30-year-old patient had an 87% chance of being readmitted within 30 days of any hospital discharge, whereas an 80-year-old patient had a 25% chance. Conclusions: Overall, 30-day readmissions are common within the first year of dialysis start. The first 10-day period after discharge, young patients, and those with poor functional status represent key areas for targeted interventions to reduce readmissions.

AB - Background/Aims: Over one-third of hospital discharges among dialysis patients are followed by 30-day readmission. The first year after dialysis start is a high-risk time frame. We examined the rate, causes, timing, and predictors of 30-day readmissions among adult, incident dialysis patients. Methods: Hospital readmissions were assessed from the 91st day to the 15th month after the initiation of dialysis using a Mayo Clinic registry linkage to United States Renal Data System claims during the period January 2001–December 2010. Results: Among 1,727 patients with ≥1 hospitalization, 532 (31%) had ≥1, and 261 (15%) had ≥2 readmissions. Readmission rate was 1.1% per person-day post-discharge, and the highest rates (2.5% per person-day) occurred ≤5 days after index admission. The overall cumulative readmission rate was 33.8% at day 30. Common readmission diagnoses included cardiac issues (22%), vascular disorders (19%), and infection (13%). Similar-cause readmissions to index hospitalization were more common during days 0–14 post-discharge than days 15–30 (37.5 vs. 22.9%; p = 0.004). Younger age at dialysis initiation, inability to transfer/ambulate, serum creatinine ≤5.3 mg/dL, higher number of previous hospitalizations, and longer duration on dialysis were associated with higher readmission rates in multivariable analyses. Patients aged 18–39 were few (8.3%) but comprised 17.7% of “high-readmission” users such that a 30-year-old patient had an 87% chance of being readmitted within 30 days of any hospital discharge, whereas an 80-year-old patient had a 25% chance. Conclusions: Overall, 30-day readmissions are common within the first year of dialysis start. The first 10-day period after discharge, young patients, and those with poor functional status represent key areas for targeted interventions to reduce readmissions.

KW - Cardiovascular disease

KW - Death

KW - Heart failure

KW - Hemodialysis

KW - Hospitalization

KW - Mortality

KW - Youth

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