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American Journal of Kidney Diseases

Dialysis Modality and Readmission Following Hospital Discharge: A Population-Based Cohort Study

Published:January 06, 2017DOI:https://doi.org/10.1053/j.ajkd.2016.10.020

      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.

      Index Words

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      References

        • Manns B.J.
        • Mendelssohn D.C.
        • Taub K.J.
        The economics of end-stage renal disease care in Canada: incentives and impact on delivery of care.
        Int J Health Care Finance Econ. 2007; 7: 149-169
        • Harel Z.
        • Wald R.
        • McArthur E.
        • et al.
        Rehospitalizations and emergency department visits after hospital discharge in patients receiving maintenance hemodialysis.
        J Am Soc Nephrol. 2015; 26: 3141-3150
      1. Canadian Institute for Health Information. All-Cause Readmission to Acute Care and Return to the Emergency Department. Ottawa, Ontario: CIHI; 2012.

        • Jencks S.F.
        • Williams M.V.
        • Coleman E.A.
        Rehospitalizations among patients in the Medicare fee-for-service program.
        N Engl J Med. 2009; 360: 1418-1428
        • Centers for Medicare and Medicaid Services
        Refining the Hospital Readmissions Reduction Program.
        Medicare Payment Advisory Commission, Washington, DCSeptember 2012 (https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/HRRP/Hospital-Readmission-Reduction-Program.html. Accessed December 28, 2016.)
        • Joynt K.E.
        • Jha A.K.
        A path forward on Medicare readmissions.
        N Engl J Med. 2013; 368: 1175-1177
        • Flythe J.E.
        • Katsanos S.L.
        • Hu Y.
        • Kshirsagar A.V.
        • Falk R.J.
        • Moore C.R.
        Predictors of 30-day hospital readmission among maintenance hemodialysis patients: a hospital's perspective.
        Clin J Am Soc Nephrol. 2016; 11: 1005-1014
        • Harel Z.
        • Wald R.
        • Perl J.
        • Schwartz D.
        • Bell C.M.
        Evaluation of deficiencies in current discharge summaries for dialysis patients in Canada.
        J Multidisciplinary Healthcare. 2012; 5: 77-84
        • Rubin H.R.
        • Fink N.E.
        • Plantinga L.C.
        • Sadler J.H.
        • Kliger A.S.
        • Powe N.R.
        Patient ratings of dialysis care with peritoneal dialysis vs hemodialysis.
        JAMA. 2004; 291: 697-703
        • Fishbane S.
        • Wish J.B.
        Quality measurement in wonderland: the curious case of a dialysis readmissions measure.
        Clin J Am Soc Nephrol. 2016; 11: 190-194
        • Erickson K.F.
        • Winkelmayer W.C.
        • Chertow G.M.
        • Bhattacharya J.
        Physician visits and 30-day hospital readmissions in patients receiving hemodialysis.
        J Am Soc Nephrol. 2014; 25: 2079-2087
        • Jain A.K.
        • Blake P.
        • Cordy P.
        • Garg A.X.
        Global trends in rates of peritoneal dialysis.
        J Am Soc Nephrol. 2012; 23: 533-544
        • Rivara M.B.
        • Mehrotra R.
        The changing landscape of home dialysis in the United States.
        Curr Opin Nephrol Hypertens. 2014; 23: 586-591
        • Austin P.C.
        Type I error rates, coverage of confidence intervals, and variance estimation in propensity-score matched analyses.
        Int J Biostat. 2009; 5 (Article 13)
        • Benchimol E.I.
        • Smeeth L.
        • Guttmann A.
        • et al.
        The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement.
        PLoS Med. 2015; 12: e1001885
        • Vandenbroucke J.P.
        • von Elm E.
        • Altman D.G.
        • et al.
        Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration.
        PLoS Med. 2007; 4: e297
        • Flythe J.E.
        • Katsanos S.L.
        • Hu Y.
        • Kshirsagar A.V.
        • Falk R.J.
        • Moore C.R.
        Predictors of 30-day hospital readmission among maintenance hemodialysis patients: a hospital's perspective.
        Clin J Am Soc Nephrol. 2016; 11: 1005-1014
        • Springel T.
        • Laskin B.
        • Furth S.
        Readmission within 30 days of hospital discharge among children receiving chronic dialysis.
        Clin J Am Soc Nephrol. 2014; 9: 536-542
        • Laurin L.P.
        • Harrak H.
        • Elftouh N.
        • Ouimet D.
        • Vallee M.
        • Lafrance J.P.
        Outcomes of infection-related hospitalization according to dialysis modality.
        Clin J Am Soc Nephrol. 2015; 10: 817-824
        • Brooke B.S.
        • Stone D.H.
        • Cronenwett J.L.
        • et al.
        Early primary care provider follow-up and readmission after high-risk surgery.
        JAMA Surg. 2014; 149: 821-828
        • Harel Z.
        • Wald R.
        • Bargman J.M.
        • et al.
        Nephrologist follow-up improves all-cause mortality of severe acute kidney injury survivors.
        Kidney Int. 2013; 83: 901-908
        • Hernandez A.F.
        • Greiner M.A.
        • Fonarow G.C.
        • et al.
        Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure.
        JAMA. 2010; 303: 1716-1722
        • Chan K.E.
        • Lazarus J.M.
        • Wingard R.L.
        • Hakim R.M.
        Association between repeat hospitalization and early intervention in dialysis patients following hospital discharge.
        Kidney Int. 2009; 76: 331-341
        • Dharmarajan K.
        • Hsieh A.F.
        • Lin Z.
        • et al.
        Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia.
        JAMA. 2013; 309: 355-363
        • Krumholz H.M.
        Post-hospital syndrome–an acquired, transient condition of generalized risk.
        N Engl J Med. 2013; 368: 100-102
        • Lukowsky L.R.
        • Mehrotra R.
        • Kheifets L.
        • Arah O.A.
        • Nissenson A.R.
        • Kalantar-Zadeh K.
        Comparing mortality of peritoneal and hemodialysis patients in the first 2 years of dialysis therapy: a marginal structural model analysis.
        Clin J Am Soc Nephrol. 2013; 8: 619-628
        • Boissinot L.
        • Landru I.
        • Cardineau E.
        • Zagdoun E.
        • Ryckelycnk J.P.
        • Lobbedez T.
        Is transition between peritoneal dialysis and hemodialysis really a gradual process?.
        Perit Dial Int. 2013; 33: 391-397
        • Al-Jaishi A.A.
        • Jain A.K.
        • Garg A.X.
        • Zhang J.C.
        • Moist L.M.
        Hemodialysis vascular access creation in patients switching from peritoneal dialysis to hemodialysis: a population-based retrospective cohort.
        Am J Kidney Dis. 2016; 67: 813-816
        • Ishani A.
        • Slinin Y.
        • Greer N.
        • et al.
        Comparative Effectiveness of Home-Based Kidney Dialysis Versus In-Center or Other Outpatient Kidney Dialysis Locations - A Systematic Review.
        Department of Veterans Affairs, Washington, DC2015
        • Schachter M.E.
        • Bargman J.M.
        • Copland M.
        • et al.
        Rationale for a home dialysis virtual ward: design and implementation.
        BMC Nephrol. 2014; 15: 33
        • Lew S.Q.
        • Sikka N.
        Are patients prepared to use telemedicine in home peritoneal dialysis programs?.
        Perit Dial Int. 2013; 33: 714-715