PUK5 A PROPENSITY SCORE-MATCHED COMPARISON OF POSTTRANSPLANT 30-DAY READMISSION BETWEEN PRETRANSPLANT DIALYSIS MODALITIES IN THE UNITED STATES

Abstract

Thirty-day readmission is defined as any unplanned hospital admission within 30 day of hospital discharge. It imposes significant economic and health burden on patients, society, providers and payers. To compare post-TX thirty-day hospital readmission between pretransplant HD and PD for adults with ESRD in the US. A propensity-matched retrospective study of renal recipients between January 2007 and December 2011, following ≥60 days of maintenance dialysis. All the data were obtained from the USRDS for the period 2006 to 2012. Adults who received either kidney or kidney/pancreas, with ≥6 months of pre-TX history were included. Patients with other organ transplants, two or more prior renal TXs, and missing data were excluded. Incidence density rates (IDR) and rate differences (R-Diff.) along with Cox proportional hazard analysis were used. Our p-value was adjusted using Bonferroni correction for multiple comparisons. A total of 19,612 renal recipients (9,806 pairs) were included. No difference in follow-up (HD=36.51 vs PD=36.08 months, p-value =0.0807). Nearly, 50% of recipients had 2-18 months of pretransplant dialysis. Of the 9,806 pairs, a total of 1,962 HD and 2,036 PD recipients had 30-readmission events, of which, >40% occurred during the first week of discharge. Patients in the PD group showed significantly higher IDR of 30-day readmission (R-Diff. =124.68/1000 person-year) compared to HD. The adjusted survival analysis indicated a nonsignificant hazard between both HD and PD (HR=0.96, p-value =0.1887). Recipients who were female, Black, publicly insured, diabetic, and those received a cadaveric organ had significant hazards of 30-day readmissions. The incidence rate of thirty-day readmission was significantly higher among PD patients especially during the first week of discharge. Although the adjusted hazard ratio showed a nonsignificant difference between HD and PD, effective measures to minimize reemission among transplant patients are required.