Hospital Readmissions among Peritoneal Dialysis Patients

Austin—Patients receiving in-center dialysis commonly require hospital readmission; however, there are few data on readmissions among patients undergoing peritoneal dialysis. Abyalew Sahlie, MD, and colleagues utilized national administrative data to examine the burden and correlates of hospital readmission among patients in the United States undergoing peritoneal dialysis. Results of the analysis were reported during a poster session at the NKF 2018 Spring Clinical Meetings in a poster titled Hospital Readmissions among US Peritoneal Dialysis Patients.

The cohort included 10,167 adults 18 to 99 years of age who were undergoing peritoneal dialysis in the United States. Eligible patients had primary Medicare coverage and an index admission (first admission after 120 days on dialysis) between January 31, 2011, and August 31, 2015. The researchers defined readmission as new hospital admissions within 30 days of index discharge. Adjusted odds ratios (ORs) for readmission were calculated using multivariable logistic regression.

Overall, 24.4% of index admissions were followed by readmission within 30 days of discharge. Patients with readmissions were more likely to have congestive heart failure (28.8% vs 22.7%; P<.001) and peripheral arterial disease (31.8% vs 23.6%; P<.001) than those without congestive heart failure. Further, patients with heart failure had longer length of stay during the index admission (median 14 vs 3 days; P<.001). There were no differences in age, sex, and race in readmission status.

Following adjustment for patient and index admission characteristics, there were associations between longer length of stay (≤4 vs ≥4 days; OR, 1.53, 95% confidence interval [CI], 1.39-1.68), peripheral arterial disease (OR, 1.35; 95% CI, 1.16-1.57), congestive heart failure (OR, 1.26; 95% CI, 1.14-1.40), ischemic heart disease (OR, 1.15; 95% CI, 1.03-1.28) and diabetes (OR, 1.11; 95% CI, 1.01-1.22) with higher likelihood of readmission. There was also an association between index admission due to peritonitis versus other causes with lower likelihood of readmission (OR, 0.77; 95% CI, 0.66-0.89).

“Nearly one-quarter of admission among peritoneal dialysis patients were followed by readmission. Our results suggest that, particularly in the absence of a peritoneal dialysis–related cause of hospitalization, care transitions of peritoneal dialysis patients are suboptimal,” the researchers concluded.

Source: Sahlie A, Galarza L, Masud T, et al. Hospital readmissions among US peritoneal dialysis patients. Abstract of a poster presented at the National Kidney Foundation 2018 Spring Clinical Meetings, April 10-14, 2018, Austin, Texas.