Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA.
Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
BMC Nephrol. 2019 Jul 29;20(1):285. doi: 10.1186/s12882-019-1473-0.
Readmission within 30 days of hospital discharge is common and costly among end-stage renal disease (ESRD) patients. Little is known about long-term outcomes after readmission. We estimated the association between hospital admissions and readmissions in the first year of dialysis and outcomes in the second year.
Data on incident dialysis patients with Medicare coverage were obtained from the United States Renal Data System (USRDS). Readmission patterns were summarized as no admissions in the first year of dialysis (Admit-), at least one admission but no readmissions within 30 days (Admit+/Readmit-), and admissions with at least one readmission within 30 days (Admit+/Readmit+).We used Cox proportional hazards models to estimate the association between readmission pattern and mortality, hospitalization, and kidney transplantation, accounting for demographic and clinical covariates.
Among the 128,593 Medicare ESRD patients included in the study, 18.5% were Admit+/Readmit+, 30.5% were Admit+/Readmit-, and 51.0% were Admit-. Readmit+/Admit+ patients had substantially higher long-term risk of mortality (HR = 3.32 (95% CI, 3.21-3.44)), hospitalization (HR = 4.46 (95% CI, 4.36-4.56)), and lower likelihood of kidney transplantation (HR = 0.52 (95% CI, 0.44-0.62)) compared to Admit- patients; these associations were stronger than those among Admit+/Readmit- patients.
Patients with readmissions in the first year of dialysis were at substantially higher risk of poor outcomes than either patients who had no admissions or patients who had hospital admissions but no readmissions. Identifying strategies to both prevent readmission and mitigate risk among patients who had a readmission may improve outcomes among this substantial, high-risk group of ESRD patients.
在终末期肾病（ESRD）患者中，出院后 30 天内再次入院是常见且代价高昂的。对于再次入院后的长期结果知之甚少。我们评估了透析第一年住院和再次入院与第二年结果之间的关系。
从美国肾脏数据系统（USRDS）获得了有医疗保险覆盖的新发透析患者的数据。将再入院模式总结为透析第一年无住院（Admit-）、至少一次住院但在 30 天内无再入院（Admit+/Readmit-）和至少一次住院并有至少一次 30 天内再入院（Admit+/Readmit+）。我们使用 Cox 比例风险模型来估计再入院模式与死亡率、住院和肾移植之间的关联，同时考虑人口统计学和临床协变量。
在纳入研究的 128593 名医疗保险 ESRD 患者中，18.5%为 Admit+/Readmit+，30.5%为 Admit+/Readmit-，51.0%为 Admit-。与 Admit-患者相比，Admit+/Admit+患者的长期死亡率（HR=3.32（95%CI，3.21-3.44））、住院率（HR=4.46（95%CI，4.36-4.56））和肾移植率（HR=0.52（95%CI，0.44-0.62））均显著更高；这些关联比 Admit+/Readmit-患者更强。
与无住院或仅有住院而无再入院的患者相比，透析第一年再次住院的患者不良结局风险显著更高。确定既能预防再入院又能减轻再入院患者风险的策略，可能会改善这一大量高风险 ESRD 患者群体的结局。
