Abstract
BackgroundPatients receiving maintenance hemodialysis (HD) and peritoneal dialysis (PD) are frequently hospitalized. Reducing unplanned 30-day hospital readmissions is a key priority for improving the quality of health care. The purpose of this study was to assess the association between the Charlson Comorbidity Index (CCI), which has been used to evaluate multi-comorbidities status, and 30-day readmission in patients on HD and PD therapy.MethodsThe Hospital Quality Monitoring System (HQMS), a national administrative database for hospitalized patients in China was used to extract dialysis patients admitted from January 2013 to December 2015. The outcome was the unplanned readmission following the hospital discharge within 30 days. For patients with multiple hospitalizations, a single hospitalization was randomly selected as the index hospitalization. A cause-specific Cox proportional hazard model was utilized to assess the association of CCI with readmission within 30 days.ResultsOf the 124,721 patients included in the study, 19,893 patients (16.0%) were identified as experiencing unplanned readmissions within 30 days. Compared with patients without comorbidity (CCI = 2, scored for dialysis), the risk of 30-day readmission increased with elevated CCI score. The hazards ratio (HR) for those with CCI 3–4, 5–6 and > 6 was 1.01 (95% confidence interval [CI] 0.98–1.05), 1.09 (95% CI 1.05–1.14), and 1.14 (95% CI 1.09–1.20), respectively.ConclusionsOur study indicated that CCI was independently associated with the risk of 30-day readmission for patients receiving dialysis including HD and PD, and could be used for risk-stratification.
Highlights
Patients receiving maintenance hemodialysis (HD) and peritoneal dialysis (PD) are frequently hospitalized
We aimed to explore the association between Charlson Comorbidity Index (CCI) and the risk of 30-day readmission in patients receiving maintenance HD and PD based on a national administrative database in China
The exclusion criteria included (1) patients without identification number and readmissions could not be identified; (2) patients diagnosed as acute kidney injury (AKI), or chronic kidney disease (CKD) stage G1–4; (3) receipt of kidney transplantation during the index hospitalization; (4) patients died during the index hospitalization; and (5) patients’ records identified as having errors, e.g., the discharge date was earlier than admission date
Summary
Patients receiving maintenance hemodialysis (HD) and peritoneal dialysis (PD) are frequently hospitalized. Compared with patients with chronic diseases but without ESKD [2], patients receiving maintenance hemodialysis (HD) and peritoneal dialysis (PD) tend to have a shorter life expectancy, as well as a higher rate of hospitalization and. The Charlson Comorbidity Index (CCI) is the most frequently used tool to measure co-existing diseases [8], and it has been validated for predicting the risk of mortality, disability, hospitalization and length of hospital stay in various clinical settings [9]. As for patients with ESKD, several studies [12, 13] have validated that the CCI was an effective tool for comorbidity assessment and it could be used for survival prediction. We aimed to explore the association between CCI and the risk of 30-day readmission in patients receiving maintenance HD and PD based on a national administrative database in China
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