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Hospital readmission in children on maintenance dialysis: a multicentre, prospective cohort study
Yeşim Özdemir Atikel1, Eszter Lévai2, Claus Peter Schmitt2
1Department of Pediatric Nephrology, Eskişehir Health Practice and Research Center, University of Health Sciences, Eskişehir, Türkiye.
Insights
Rehospitalization is common in pediatric dialysis patients, with many 30-day readmissions being preventable. Interventions should address modifiable factors like anemia and access complications to reduce readmission rates.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- Limited data exist on rehospitalization patterns in pediatric dialysis patients.
- Understanding readmission rates and risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To identify indications, rates, and risk factors for 30-day readmissions in pediatric dialysis patients.
- To differentiate between potentially preventable and early readmissions.
Main Methods:
- Prospective multinational, multicenter cohort study of hemodialysis (HD) and peritoneal dialysis (PD) patients.
- Readmission defined as hospitalization within 30 days of discharge.
- Analysis of potentially preventable and early readmissions.
Main Results:
- 31% of pediatric dialysis patients experienced at least one readmission within 30 days.
- Hemodialysis patients had higher early readmission rates compared to peritoneal dialysis patients.
- Dialysis access complications and infections were primary causes; 47% of readmissions were potentially avoidable.
Conclusions:
- Readmissions are frequent in pediatric dialysis patients, with a significant portion being preventable.
- Interventions targeting modifiable factors (access complications, anemia, recovery status) are essential.
- Younger age and hemodialysis are non-modifiable risk factors for readmission.
Background:
Limited data exist on rehospitalization in paediatric dialysis patients. The objective of this study was to identify indications, rates and risk factors for 30-day readmissions in this population.
Methods:
We used a prospective multinational, multicentre cohort study of haemodialysis (HD) and peritoneal dialysis (PD) patients discharged between July 2017 and July 2018. 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 occurring within 7 days of discharge. The primary outcome was 30-day readmission. Secondary outcomes included potentially avoidable and early readmissions.
Results:
A total of 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% versus 31.1%; hazard ratio [HR] 1.06 [95% confidence interval (CI) 0.61-1.81]}. Compared with PD, HD patients had a significantly shorter time to readmission (8 versus 14 days; P = .019), higher early readmission rates (46% versus 18%; P = .010) and risk [odds ratio (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 haemoglobin levels were linked to readmission [HR 0.78 (95% CI 0.64-0.95)]. Bicarbonate use was associated with a 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 0.99(95%CI 0.98-0.99), respectively].
Conclusions:
Readmissions are common in paediatric dialysis patients, with a substantial proportion being potentially preventable. To reduce rehospitalizations, interventions should target modifiable factors such as access complications, anaemia and incomplete recovery at discharge, while recognizing non-modifiable risks like HD and younger age to identify high-risk patients.
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