Reducing hospital readmissions in patients with end-stage kidney disease.

ESKD patients have a large burden of disease, with high rates of readmission to hospital compared with the general population. A readmission after an acute index hospital discharge is either planned or unplanned. A proportion of unplanned readmissions are potentially avoidable, and could have been prevented with optimized transitional care. Readmissions pose financial cost to the health care system and emotional cost to patients and caregivers. In other chronic diseases with high readmission risk, such as congestive heart failure, interventions have improved transitional care and reduced readmission risk. In reviewing the existing literature on readmissions in ESKD, the definition and risk of readmission varied widely by study, with many potentially associated factors including comorbid diseases such as anemia and hypoalbuminemia. An ESKD patient's requisite follow-up in the outpatient dialysis facility provides an opportunity to improve transitional care at the time of discharge. Despite this, our review of existing literature found no studies which have tested interventions to reduce the risk of readmission in ESKD patients. We propose a framework to define the determinants of avoidable readmission in ESKD, and use this framework to define a research agenda. Avoidable readmissions in ESKD patients is a topic prime for in-depth study, given the high-risk nature in this patient population, financial and societal costs, and potential for risk modification through targeted interventions.