番茄社区

AUSTIN, Texas -- Peritoneal dialysis patients may require closer monitoring following a hospital discharge, researchers suggested here.

In a cohort or 10,167 index hospital admissions for peritoneal dialysis patients, nearly 25% experienced a readmission within 30 days, according to senior study author Laura Plantinga, PhD, of Emory University School of Medicine, and colleagues.

Presenting at the , the research group reported several clinical factors that were associated with a higher risk for readmission, in an adjusted model:

• Longer length of stay (≥4 versus <4 days): OR 1.53 (95% CI 1.39-1.68)
• Peripheral arterial disease: 1.35 (95% CI 1.16-1.57)
• Congestive heart failure: 1.26 (95% CI 1.14-1.40)
• Ischemic heart disease: 1.15 (95% CI 1.03-1.28)
• Diabetes: 1.11 (95% CI 1.01-1.22)

"Our findings were surprising in that readmission risk was the same, if not higher, among U.S. peritoneal dialysis patients than we had seen among U.S. in-center hemodialysis patients in previous studies," Plantinga said.

"Most of the factors we identified as being associated with higher readmission risk, including longer length of stay in the index admission and comorbid conditions (e.g., heart failure, ischemic heart disease, peripheral vascular disease, and diabetes), were less surprising, given they are general risk factors for readmission."

But an index admission due to peritonitis, as opposed to other causes, was actually tied to a significantly lower risk for readmission among these patients (OR 0.77, 95% CI 0.66-0.89) -- another finding Plantinga told 番茄社区 was unexpected.

Plantinga highlighted how most prior readmission studies including ESRD patients have mainly focused on patients receiving in-center hemodialysis, which is "due to recent policy changes that hold both dialysis facilities and hospitals accountable for 30-day readmissions among hemodialysis patients."

Because of this, there was generally not much information available regarding the clinical details and frequency of readmissions for peritoneal dialysis patients, she explained. "There was little information on what factors were associated with readmissions in this population, which could help target interventions. This information is even more important in light of increasing use of home modalities, including peritoneal dialysis, in the United States."

This cohort included peritoneal dialysis patients over the age of 18. Individuals were excluded from the retrospective analysis if he or she were admitted for a kidney transplant, died during or within 30 days of hospitalization, or if he or she were discharged against medical advice.

An index admission was defined as the first admission after 120 days had lapsed, while a readmission included a hospitalization within 30 days of the prior discharge date.

Although the cause of most patient's readmissions were listed as "other," infections (30.8%) and cardiovascular-related events (25.4%) were two prominent causes for readmission overall.

Some limitations to the study include an inability to control for potentially confounding factors, such as the severity of comorbid conditions.

Overall, Plantinga suggested these high readmission rates among peritoneal dialysis patients may be, at least in part, due to less frequent provider contact, as compared to in-center hemodialysis patients.

"These results, together with our finding of lower readmission risk among patients admitted for peritonitis -- which would likely be closely monitored in the post-discharge period -- suggests that there are missed opportunities for improving care transitions at hospital discharge in this population," she concluded.

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