Hospital readmissions among adults with chronic kidney disease by HIV status in the United States

To characterize all-cause unplanned 30-day readmissions among adults with chronic kidney disease (CKD) of all-stages by HIV status in the United States.

A retrospective cohort study using the Nationwide Readmissions Database-an all-payer nationally representative database.

Index (i.e., initial) admissions and readmissions were defined following the United States Centers for Medicare & Medicaid Services (CMS) guidelines. We evaluated trends in the readmission risk among adults by CKD and HIV status during 2016-2022 and compared the overall and subgroup-specific readmission risk by HIV status among adults with CKD in 2022. Crude and age and sex-adjusted risk ratios (aRRs) were calculated using average marginal estimates from mixed-effect logistic regressions. Survey weights were applied.

Among people with CKD, the readmission risk declined from 33.4% in 2016 to 29.1% in 2022 for people with HIV (PWH) and declined from 23.7% in 2016 to 21.9% in 2022 for people without HIV (PWoH). In 2022, there were 43 087 index admissions from PWH and 5 170 351 from PWoH. PWH were more likely to be men, younger, have end-stage CKD, and reside in low-income areas vs. PWoH. For both PWH and PWoH, the readmission risk increased with more advanced CKD stages but decreased with older age. In 2022, PWH were more likely to be readmitted than PWoH (aRR = 1.20 [95% confidence interval, 95% CI: 1.17-1.23]). This disparity was greater among those less than 40 years of age (aRR = 1.32 [95% CI: 1.23-1.42]).

More efforts are needed to mitigate the excessive readmission burden of people with CKD. PWH, especially young individuals, could represent a critical group for intensified intervention in CKD readmission prevention programs.