Burden and correlates of readmissions related to pulmonary edema in US hemodialysis patients: a cohort study. Issue 7 (25th December 2017)

• Record Type: Journal Article
• Authors: Plantinga, Laura C; King, Laura M; Masud, Tahsin; Shafi, Tariq; Burkart, John M; Lea, Janice P; Jaar, Bernard G
• Is Part Of: Nephrology dialysis transplantation. Volume 33:Issue 7(2018)
• Page Start: 1215
• Page End: 1223
• Publication Date: 2017-12-25
• Subjects: dialysis -- fluid overload -- pulmonary edema -- readmission -- rehospitalization; Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfx335
• Languages: English
• ISSNs: 0931-0509

Abstract

ABSTRACT: Background: 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. Methods: 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. Results: 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. Conclusions: 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.