Department of Medicine, Emory University, Atlanta, GA, USA.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Nephrol Dial Transplant. 2018 Jul 1;33(7):1215-1223. doi: 10.1093/ndt/gfx335.
Pulmonary edema is prevalent and may be a common cause of hospital readmissions in hemodialysis patients. We aimed to estimate the national burden of, and identify correlates of, readmissions related to pulmonary edema among hemodialysis patients.
In this retrospective cohort study using national registry data, we identified prevalent US hemodialysis patients (n = 215 251) with index admissions while under Medicare primary coverage in 2011-13. We defined readmissions as admissions occurring within 30 days of the index discharge and pulmonary edema-related readmissions as readmissions with discharge diagnoses of fluid overload, heart failure or pulmonary edema. Multivariable logistic regression models were used to determine odds ratios (ORs) for pulmonary edema-related readmissions by patient and index admission characteristics.
About one-quarter (23%) of index hospital admissions were followed by a readmission, with nearly half (44%) of the readmissions being associated with pulmonary edema. The strongest independent correlate of pulmonary edema-related readmission was a pulmonary edema-related index admission [OR = 2.32; 95% confidence interval (CI) 2.22-2.41]. With the exception of dialysis vintage <1 year (OR = 1.18; 95% CI 1.14-1.22), chronic obstructive pulmonary disease (OR = 1.34; 95% CI 1.29-1.38), dialysis non-compliance (OR = 1.53; 95% CI 1.41-1.64) and congestive heart failure (OR = 1.85; 95% CI 1.77-1.93), patient characteristics were not generally associated with higher risk of pulmonary edema-related readmission.
Readmissions related to pulmonary edema are common in hemodialysis patients. Interventions aimed at preventing such readmissions could have a substantial impact on readmissions overall, particularly targeted at incident hemodialysis patients with a prior history of heart failure and patients initially admitted for pulmonary edema.
肺水肿在血液透析患者中很常见，可能是导致其住院的常见原因。本研究旨在评估肺水肿相关再入院的全国负担，并确定其与血液透析患者的相关因素。
本回顾性队列研究使用全国登记数据，纳入了 2011 年至 2013 年期间在医疗保险初级保险下首次住院的 215251 例美国血液透析患者。我们将再入院定义为索引出院后 30 天内的入院，肺水肿相关再入院则定义为出院诊断为液体过载、心力衰竭或肺水肿的再入院。采用多变量逻辑回归模型，根据患者和索引入院特征确定与肺水肿相关的再入院的优势比（OR）。
约四分之一（23%）的索引住院入院后发生再入院，其中近一半（44%）的再入院与肺水肿相关。与肺水肿相关的再入院的最强独立相关因素是与肺水肿相关的索引入院[OR=2.32；95%置信区间（CI）2.22-2.41]。除透析龄<1 年（OR=1.18；95%CI 1.14-1.22）、慢性阻塞性肺疾病（OR=1.34；95%CI 1.29-1.38）、透析不依从（OR=1.53；95%CI 1.41-1.64）和充血性心力衰竭（OR=1.85；95%CI 1.77-1.93）外，患者特征通常与肺水肿相关再入院的风险增加无关。
肺水肿相关再入院在血液透析患者中很常见。旨在预防此类再入院的干预措施可能对整体再入院产生重大影响，特别是针对有心力衰竭既往史和因肺水肿初次入院的新血液透析患者。
