Abstract TH160: Hypertensive Emergencies Among End-Stage Renal Disease Patients and Predictors of All-Cause 30-Day Readmissions

Background: End-stage renal disease (ESRD) patients are at heightened risk for hypertensive emergencies(HE) due to complex hemodynamic and vascular abnormalities. This study aims to explore the mortality rates of ESRD patients during their initial admission for HE while also focusing on 30-day readmissions of survivors. Methods: The Nationwide Readmission Database(NRD)(2020-2022) was queried for this study. All COVID-19 patients were removed. We first identified the number of admissions between January and November with a primary code for HE (ICD-10 code I16.1) among ESRD patients (ICD-10 code N18.6). Their all-cause mortality rate and adjusted odds ratios during their initial hospitalization were found. The all-cause readmission rates within 30 days of discharge were calculated. We applied multivariable regression models to estimate the predictors of readmissions. We also estimated the mortality rates among the readmissions. Results: Among 174,937 hospitalizations for HE, 15.47% (n=27,060) occurred in patients with ESRD. ESRD patients were significantly younger (mean age: 53.78 vs. 61.05 years; p < 0.01) but had higher in-hospital mortality compared to non-ESRD patients (0.66% vs. 0.32%), with an adjusted odds ratio(aOR) of 1.81 (95% CI, 1.41-2.34; p<0.01). Of the 26,882 ESRD patients who survived the index admission, 30.72% were readmitted within 30 days. Predictors of higher odds of 30-day readmission included coagulopathy (aOR 1.16, 95% CI: 1.02-1.33; p=0.029), congestive heart failure (aOR 1.23, 95% CI: 1.13-1.35; p<0.01), homelessness (aOR 1.78, 95% CI: 1.21-2.61; p<0.01), COPD (aOR 1.46, 95% CI: 1.30-1.65; p<0.01), female sex (aOR 1.21, 95% CI: 1.12-1.31; p<0.01), diabetes (aOR 1.13, 95% CI: 1.04-1.23; p<0.01), and smoking (aOR 1.12, 95% CI: 1.03-1.22; p<0.01). In contrast, lower odds of readmission were observed among patients older than 60 years (aOR 0.69, 95% CI: 0.63-0.76; p<0.01), those with obesity (aOR 0.72, 95% CI: 0.63-0.83; p<0.01), or dyslipidemia (aOR 0.86, 95% CI: 0.78-0.94; p<0.01). Mortality during 30-day readmissions was 2.12%. Conclusion: Our study confirms that various factors can impact readmission among ESRD patients who survive an initial admission for HE, with a higher mortality rate during subsequent readmissions. Such findings underscore the need to establish effective discharge strategies and proper outpatient follow-up protocols to reduce readmissions and improve long-term survival.