Abstract

PONCE, Pedro. Hospital admission and early readmission rates in haemodialysis patients. Port J Nephrol Hypert [online]. 2015, vol.29, n.4, pp.338-344. ISSN 0872-0169.

Rationale More than 35% of all haemodialysis (HD) patients admitted to a hospital are readmitted in the next 30 days after discharge, with high morbidity, mortality and costs. It is suspected that serious flaws in fluid and anaemia management during the hospitalization, which are not detected and corrected upon reentry in the outpatient programme, can be a cause. We tried to quantify this phenomenon and clarify its causes and opportunities for prevention. Patients and Methods Retrospective registry study including all patients of NephroCare Portugal network that were submitted to a hospital admission (admission 1) during 2013 and 2014. Two groups were identified: Group A - Patients that had a new admission (admission 2) in the 30 days after discharge of the index admission (admission 1), Group B - Patients that were not readmitted. Causes for hospital admission: hydration status, haemoglobin values, ESA and dry weight prescriptions, and blood pressure control were analysed pre-and post-hospital admission 1. Results A total of 4546 patients were included for analysis registering a hospitalization rate of 0.63 episodes/patient-year. The overall 30 days hospital readmission rate was 34.9% (22.9% in 2013 and 44.7% in 2014). In Group A, with 634 first admissions, there was a significant difference between the normohydrated weight as determined by BCM before and after the first admission: Average weight 65.6 (± 14.7) vs. 63.7 (± 13.9)kg, p < 0.0001 (CI 2.2 - 1.5), as well as a difference between the prescribed dry weight pre- and post-admission: 65.9 (± 14.0) vs. 64.6 (p < 0.0001 (CI 1.6 - 1.2). In group B there was a significant difference between the normohydrated weight as determined by BCM before and after the index admission: Average weight 65.6 (± 14.6) vs. 64.3 (± 14.3)kg, p < 0.0001 (95% CI 1.1 - 1.6), as well as a difference between the prescribed dry weight pre-and post-admission: 65.6 (± 14.1) vs. 64.7 (p < 0.0001 (95% CI 0.8 - 1.1). All patients in Group A and 46.9% of those in Group B were severely overhydrated (> 15%) after discharge from the index admission, Dry weight was decreased in that month in 72% of Group A patients and in 39.1% of Group B, leaving 28.1% of patients in group A without a proper prescription and only 7.8% in Group B. Differences between the two groups for anaemia treatment and B.P. measurements were not clinically relevant. Conclusions The 30 day-Hospital readmission rate is extremely elevated. In the present series, the best opportunity for prevention of these readmission events seems to be a better fluid management immediately after discharge

Keywords : Haemodialysis; hospital admission.

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