Hemodialysis: Early readmission associated with mortality
In the United States, readmission of patients with end-stage renal disease (ESRD) seems to be independently associated with a substantially increased risk of mortality, say researchers at the Emory University in Atlanta. They point out that the standardized readmissions ratio (SRR) was recently introduced as a quality measure for both hospitals and dialysis facilities, but remained a controversial measure for dialysis facilities. In addition, the authors report a lack of data evaluating the timing of readmissions, which “determines the window in which dialysis providers could act to prevent readmission”. The present study examined the timing of readmissions of hemodialysis patients in the United States and its association with mortality.
The study included 285,795 adult hemodialysis patients who had had at least one hospitalization in 2010-2013 (first index) and survived for 30 days or more. Readmission timing was defined as 0-7, 8-14, or 15-30 days after the index discharge.
Overall, 23.1 % of patients were readmitted to hospital within 30 days of the index discharge, 35.9 % of which within the first week. Regardless of timing, patients with readmissions had a higher risk of death within one year than those with no readmissions: The hazard ratio (HR) of mortality was 2.04 when readmitted within 15-30 days, 1.98 when readmitted within 8-14 days and 1.76 when readmitted within 0-7 days.
On the basis of these data, the authors concur that the opportunities for dialysis providers to intervene and prevent early readmission “may be limited”. Nevertheless, it is important to note the independent association between readmission and a substantially increased risk of mortality in this population.