Emergency department visits for hemodialysis by insurance status in the United States. Issue 2 (19th April 2022)

• Record Type: Journal Article
• Authors: West, Julianna; Chan, Hei Kit; Wang, Henry; Molony, Donald; Foringer, John; Huebinger, Ryan; Robinson, David; Chavez, Summer
• Is Part Of: JACEP open. Volume 3:Issue 2(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-04-19
• Subjects: chronic dialysis -- chronic hemodialysis -- dialysis -- end‐stage kidney disease -- end‐stage renal disease -- ESRD -- hemodialysis; Medical emergencies -- Periodicals; 616.025
• DOI: 10.1002/emp2.12698
• Languages: English
• ISSNs: 0361-1124

Abstract

Abstract: Objective: Many uninsured patients with end‐stage kidney disease (ESKD) depend upon the emergency department (ED) for hemodialysis (HD). We sought to characterize ED visits for emergent HD by insurance status. Methods: We performed a cross‐sectional analysis of the 2017 Nationwide Emergency Department Sample, including ED visits by patients ≥18 years old with a length of stay ≤1 day and performance of HD. Insurance status determined by "insured" as Medicare, Medicaid, or commercial and "uninsured" as self‐pay or charity. Results: Of 118, 034, 396 adult ED visits, 235, 988 were associated with HD: uninsured 62, 503 (incidence 5.30 per 10, 000, 95% confidence interval [CI]: 5.26–5.34) and insured 172, 889 (incidence 14.65 per 10, 000, 95% CI: 14.60–14.74). The south census region accounted for 89% of uninsured ED HD (odds ratio [OR] 31.55, 95% CI: 8.97–110.97). Compared to insured patients, uninsured ED HD patients were more likely to be younger (age 18–44, 37.6% vs 19.9%). The most common primary diagnosis for uninsured and insured ED HD patients was hypertensive chronic kidney disease (34.6% and 26.2%, respectively). Uninsured ED HD patients were less likely to be admitted (3.4% vs 36.0%, OR 0.06, 95% CI: 0.02–0.20). Most ED HD patients were discharged home (95.2% uninsured vs 57.6% insured). ED charges per visit were $5, 992.32 for uninsured and $10, 985.87 for insured ED HD patients. Conclusions: Our findings highlight the health care burden of ED HD. Novel system approaches are needed for the management of uninsured and insured patients with ESKD.