Heterogeneous 30-day readmission risk in diabetic kidney disease: a nationwide analysis stratified by phenotype, age, and socioeconomic status

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Background Diabetic kidney disease (DKD) carries substantial hospital readmission burden. We characterized 30-day readmission patterns following DKD hospitalization, with stratified analyses by phenotype, age, and social determinants of health (SDOH). Methods Using the 2018 Nationwide Readmissions Database (NRD) with complex survey-weighted analyses (DISCWT), we identified adult index hospitalizations with a principal DKD diagnosis (January–November 2018). Survey-weighted multivariable logistic regression and Wald interaction tests identified independent readmission predictors. Results Among 1,291,033 index hospitalizations (weighted estimate ~ 2.37 million), the 30-day all-cause readmission rate was 15.96% (95% CI: 15.78%–16.14%), significantly higher for type 1 than type 2 DKD (22.42% vs. 15.69%; p < 0.001). Non-DKD systemic diagnoses accounted for 91.97% of readmissions. Type 1 DKD exhibited a pronounced inverse age–readmission gradient (28.8% in patients < 40 years to 15.2% in those > 79 years; age×phenotype interaction p = 9.3×10⁻¹⁴). The strongest independent predictors were ESRD (aOR 1.591), heart failure (aOR 1.348), anemia (aOR 1.208), COPD (aOR 1.194), and type 1 DKD status (aOR 1.288; all p < 0.001). Medicaid insurance independently predicted higher readmission risk (aOR 1.037; 95% CI: 1.007–1.069; p = 0.016). Model discrimination was modest (C-statistic: 0.61). Conclusions Readmission risk in DKD is heterogeneous across diabetes phenotype, age, and socioeconomic strata, driven predominantly by non-DKD systemic comorbidities. Medicaid reliance and low income independently worsen outcomes, underscoring the critical role of SDOH in guiding targeted transitional care.