Abstract
BackgroundDialysis patients who miss treatments are twice as likely to visit emergency departments (EDs) compared to adherent patients; however, prospective studies assessing ED use after missed treatments are limited. This interdisciplinary pilot study aimed to identify social determinants of health (SDOH) associated with missing hemodialysis (HD) and presenting to the ED, and describe resource utilization associated with such visits.MethodsWe conducted a prospective observational study with a convenience sample of patients presenting to the ED after missing HD (cases); patients at local dialysis centers identified as HD-compliant by their nephrologists served as matched controls. Patients were interviewed with validated instruments capturing associated risk factors, including SDOH. ED resource utilization by cases was determined by chart review. Chi-square tests and ANOVA were used to detect statistically significant group differences.ResultsAll cases visiting the ED had laboratory and radiographic studies; 40% needed physician-performed procedures. Mean ED length of stay (LOS) for cases was 17 h; 76% of patients were admitted with average LOS of 6 days. Comparing 25 cases and 24 controls, we found no difference in economic stability, educational attainment, health literacy, family support, or satisfaction with nephrology care. However, cases were more dependent on public transport for dialysis (p = 0.03). Despite comparable comorbidity burdens, cases were more likely to have impaired mobility, physical limitations, and higher severity of pain and depression. (p < 0.05).ConclusionsED visits after missed HD resulted in elevated LOS and admission rates. Frequently-cited SDOH such as health literacy did not confer significant risk for missing HD. However, pain, physical limitations, and depression were higher among cases. Community-specific collaborations between EDs and dialysis centers would be valuable in identifying risk factors specific to missed HD and ED use, to develop strategies to improve treatment adherence and reduce unnecessary ED utilization.
Highlights
Dialysis patients who miss treatments are twice as likely to visit emergency departments (EDs) compared to adherent patients; prospective studies assessing Emergency Department (ED) use after missed treatments are limited
We controlled for gender, age, diabetic status, and years on dialysis, and, groups did not differ significantly in these factors. (p > 0.05) (Table 1) Most participants were AfricanAmerican and had been on HD for less than 5 years. 44.9% were female; 32.7% were diabetic
To address the aforementioned evidence gaps, we prospectively examined risk factors predicting ED visits among patients who had been non-adherent to dialysis
Summary
Dialysis patients who miss treatments are twice as likely to visit emergency departments (EDs) compared to adherent patients; prospective studies assessing ED use after missed treatments are limited. This interdisciplinary pilot study aimed to identify social determinants of health (SDOH) associated with missing hemodialysis (HD) and presenting to the ED, and describe resource utilization associated with such visits. With subsequent rising costs and ED overcrowding, there is an increased focus on identifying patients at higher risk of frequent, possibly preventable, visits [3,4,5] Such patients include those undergoing dialysis for end-stage renal disease (ESRD) [3, 6]. Among ESRD patients who shorten or miss dialysis treatments, the risk of ED care further doubles and the risk of re-hospitalization quadruples; missed dialysis treatments are associated with all-cause mortality and worse health [11,12,13,14]
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