Jeffrey Perl1, Eric McArthur2, Chaim Bell3, Amit X Garg4, Joanne M Bargman5, Christopher T Chan5, Shai Harel6, Lihua Li2, Arsh K Jain4, Danielle M Nash2, Ziv Harel7. 1. Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: jeff.perl@utoronto.ca. 2. Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada. 3. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. 4. Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, London Health Sciences Centre, Western University, London, Ontario, Canada. 5. Division of Nephrology, University Health Network, University of Toronto, Ontario, Canada. 6. Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. 7. Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Readmissions following hospital discharge among maintenance dialysis patients are common, potentially modifiable, and costly. Compared with patients receiving in-center hemodialysis (HD), patients receiving peritoneal dialysis (PD) have fewer routine dialysis clinic encounters and as a result may be more susceptible to a hospital readmission following discharge. STUDY DESIGN: Population-based retrospective-cohort observational study. SETTINGS & PARTICIPANTS: Patients treated with maintenance dialysis who were discharged following an acute-care hospitalization during January 1, 2003, to December 31, 2013, across 164 acute-care hospitals in Ontario, Canada. For those with multiple hospitalizations, we randomly selected a single hospitalization as the index hospitalization. PREDICTOR: Dialysis modality PD or in-center HD. Propensity scores were used to match each patient on PD therapy to 2 patients on in-center HD therapy to ensure that baseline indicators of health were similar between the 2 groups. OUTCOME: All-cause 30-day readmission following the index hospital discharge. RESULTS: 28,026 dialysis patients were included in the study. 4,013 PD patients were matched to 8,026 in-center HD patients. Among the matched cohort, 30-day readmission rates were 7.1 (95% CI, 6.6-7.6) per 1,000 person-days for patients on PD therapy and 6.0 (95% CI, 5.7-6.3) per 1,000 person-days for patients on in-center HD therapy. The risk for a 30-day readmission among patients on PD therapy was higher compared with those on in-center HD therapy (adjusted HR, 1.19; 95% CI, 1.08-1.31). The primary results were consistent across several key prespecified subgroups. LIMITATIONS: Lack of information for the frequency of nephrology physician encounters following discharge from the hospital in both the PD and in-center HD cohorts. Limited validation of International Classification of Diseases, Tenth Revision codes. CONCLUSIONS: The risk for 30-day readmission is higher for patients on home-based PD compared to in-center HD therapy. Interventions to improve transitions in care between the inpatient and outpatient settings are needed, particularly for patients on PD therapy.
BACKGROUND: Readmissions following hospital discharge among maintenance dialysis patients are common, potentially modifiable, and costly. Compared with patients receiving in-center hemodialysis (HD), patients receiving peritoneal dialysis (PD) have fewer routine dialysis clinic encounters and as a result may be more susceptible to a hospital readmission following discharge. STUDY DESIGN: Population-based retrospective-cohort observational study. SETTINGS & PARTICIPANTS: Patients treated with maintenance dialysis who were discharged following an acute-care hospitalization during January 1, 2003, to December 31, 2013, across 164 acute-care hospitals in Ontario, Canada. For those with multiple hospitalizations, we randomly selected a single hospitalization as the index hospitalization. PREDICTOR: Dialysis modality PD or in-center HD. Propensity scores were used to match each patient on PD therapy to 2 patients on in-center HD therapy to ensure that baseline indicators of health were similar between the 2 groups. OUTCOME: All-cause 30-day readmission following the index hospital discharge. RESULTS: 28,026 dialysis patients were included in the study. 4,013 PDpatients were matched to 8,026 in-center HDpatients. Among the matched cohort, 30-day readmission rates were 7.1 (95% CI, 6.6-7.6) per 1,000 person-days for patients on PD therapy and 6.0 (95% CI, 5.7-6.3) per 1,000 person-days for patients on in-center HD therapy. The risk for a 30-day readmission among patients on PD therapy was higher compared with those on in-center HD therapy (adjusted HR, 1.19; 95% CI, 1.08-1.31). The primary results were consistent across several key prespecified subgroups. LIMITATIONS: Lack of information for the frequency of nephrology physician encounters following discharge from the hospital in both the PD and in-center HD cohorts. Limited validation of International Classification of Diseases, Tenth Revision codes. CONCLUSIONS: The risk for 30-day readmission is higher for patients on home-based PD compared to in-center HD therapy. Interventions to improve transitions in care between the inpatient and outpatient settings are needed, particularly for patients on PD therapy.
Authors: Karthik K Tennankore; Annie-Claire Nadeau-Fredette; Kara Matheson; Christopher T Chan; Emilie Trinh; Jeffrey Perl Journal: Kidney360 Date: 2021-10-22
Authors: Lili Chan; Kinsuk Chauhan; Priti Poojary; Aparna Saha; Elizabeth Hammer; Joseph A Vassalotti; Lindsay Jubelt; Bart Ferket; Steven G Coca; Girish N Nadkarni Journal: Clin J Am Soc Nephrol Date: 2017-09-28 Impact factor: 8.237
Authors: Laura C Plantinga; Tahsin Masud; Janice P Lea; John M Burkart; Christopher M O'Donnell; Bernard G Jaar Journal: BMC Nephrol Date: 2018-07-31 Impact factor: 2.388
Authors: Lauren H Wyatt; Yuzhi Xi; Abhijit Kshirsagar; Qian Di; Cavin Ward-Caviness; Timothy J Wade; Wayne E Cascio; Ana G Rappold Journal: BMJ Open Date: 2020-12-15 Impact factor: 2.692
Authors: Miquel Sitjar-Suñer; Rosa Suñer-Soler; Afra Masià-Plana; Emilia Chirveches-Pérez; Carme Bertran-Noguer; Concepció Fuentes-Pumarola Journal: Int J Environ Res Public Health Date: 2020-06-14 Impact factor: 3.390