Abstract
BackgroundReadmission 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.MethodsData 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.ResultsAmong 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.ConclusionsPatients 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.
Highlights
Readmission within 30 days of hospital discharge is common and costly among end-stage renal disease (ESRD) patients
Readmission within 30 days is associated with 1-year mortality in the community-dwelling Medicare population [9], and we have previously demonstrated an association between readmission and 1-year mortality among prevalent ESRD patients [10]
Patient characteristics by first-year readmission pattern Among the 128,593 Medicare patients included in the study, 18.5% were Admit+ / Readmit+, while 30.5% were Admit+ / Readmit, and about half (51.0%) were Admit- in the first year (Table 1)
Summary
Readmission within 30 days of hospital discharge is common and costly among end-stage renal disease (ESRD) patients. End-stage renal disease (ESRD) patients on hemodialysis experience a high burden of hospital admission and readmission. In 2015, ESRD patients were admitted to the hospital 1.7 times per year on average, and about 35% of hospital discharges among these patients were followed by a readmission within 30 days of discharge [1] – almost double the readmission rate of the general Medicare population. This contributes to the overall economic burden of ESRD, as approximately one-third of Medicare expenditures for ESRD patients are for inpatient costs [1].
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