Thirty-one percent of pediatric dialysis patients were readmitted within 30 days, with lower hemoglobin and dialysis access complications being major risk factors.
Does hemodialysis compared to peritoneal dialysis affect the rate and timing of 30-day readmissions in pediatric dialysis patients?
Readmissions are common in pediatric dialysis patients, with HD patients at higher risk for early readmission compared to PD patients, highlighting the need to target modifiable risk factors like access complications and anemia.
Absolute Event Rate: 0% vs 0%
Abstract Importance Limited data exists on rehospitalization in pediatric dialysis patients. Objective To identify indications, rates, and risk factors for 30-day readmissions in this population. Design Prospective cohort study. Setting Multinational, multicenter. Participants Hemodialysis (HD) and peritoneal dialysis (PD) patients discharged between July 2017 and July 2018. Exposures Readmission was identified as repeat hospitalization within 30 days of a prior (index) admission. Potentially preventable readmissions were clinically related to the initial admission. Early readmissions were those occuring within seven days of discharge. Main outcomes and measures The primary outcome was 30-day readmission. Secondary outcomes included potentially avoidable and early readmissions. Results 54 (31%) of 176 patients (102 PD,74 HD) had at least one readmission. 84 (18%) discharges were followed by readmission. PD and HD patients had similar readmission rates (30.4% vs. 31.1%; HR: 1.06 ,95% CI 0.61-1.81). Compared to PD, HD patients had significantly shorter time to readmission (8 vs. 14 days, P=0.019), higher early readmission rates (46% vs 18%, P=0.010) and risk (OR: 3.87; 95% CI 1.35–11.11). Main readmission causes were dialysis access-related non-infectious complications (31%) and access infections (22.7%). 47% of readmissions were potentially avoidable. Lower hemoglobin levels linked to readmission (HR=0.78, 95% CI 0.64-0.95). Bicarbonate use was associated with 51% lower readmission risk (HR=0.49, 95% CI 0.24-0.99). Neurological comorbidity (OR: 7.00; 95% CI 1.04–47.22) and partial recovery (OR: 56.45; 95% CI 3.02–1053.10) were risk factors for avoidable readmission. Risk of avoidable and early readmission decreased with age (OR:0.98; 95% CI 0.97-0.99 and OR: 0.989; 95% CI= 0.980-0.99, respectively). Conclusions and Relevance Readmissions are common in pediatric dialysis patients, with a substantial proportion potentially preventable. To reduce rehospitalizations, interventions should target modifiable factors such as access complications, anemia, and incomplete recovery at discharge, while recognizing non-modifiable risks like hemodialysis and younger age to identify high-risk patients.
Atikel et al. (Mon,) reported a other. Thirty-one percent of pediatric dialysis patients were readmitted within 30 days, with lower hemoglobin and dialysis access complications being major risk factors.