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Clinical and Social Risk Factors for 30-Day Readmissions in Children With Kidney Disease
Leonela Villegas1, Rui Xiao2, Lilia Cervantes3
1Division of Pediatric Nephrology, Connecticut Children's Medical Center, Hartford, Connecticut; Division of Pediatric Nephrology, Children's Hospital of Philadelphia.
Insights
Hospital readmissions are common in pediatric chronic kidney disease (CKD), affecting 12.8% of patients. Clinical complexity and mental health issues are key drivers, necessitating targeted interventions to reduce readmissions.
Area of Science:
- Pediatric Nephrology
- Healthcare Outcomes Research
- Public Health
Background:
- Hospital readmissions pose a significant burden in pediatric chronic kidney disease (CKD).
- The epidemiology and contributing factors to readmission in this population are not well understood.
- Understanding these factors is crucial for improving care and reducing healthcare costs.
Purpose of the Study:
- To evaluate 30-day all-cause readmission rates in U.S. pediatric patients with CKD.
- To identify clinical and social factors associated with these readmissions.
- To inform strategies for reducing preventable hospitalizations.
Main Methods:
- Retrospective cohort study utilizing data from the Pediatric Health Information System (PHIS).
- Included children aged ≤18 years diagnosed with CKD between January 2016 and June 2021.
- Multivariable logistic regression analysis was performed to identify predictors of readmission.
Main Results:
- 12.8% of pediatric CKD patients (n=48,228) experienced 30-day readmission; 22.3% of those with kidney failure were readmitted.
- Factors associated with increased readmission risk included glomerular CKD etiology, complex chronic disease, higher illness severity, longer length of stay, and mental health comorbidity.
- Urban residence was linked to higher readmission, while insurance type, neighborhood income, and Child Opportunity Index were not significant predictors.
Conclusions:
- Nearly 1 in 8 children with CKD and 1 in 5 with kidney failure are readmitted within 30 days.
- Readmission risk is primarily driven by clinical complexity, illness severity, and mental health comorbidities.
- Findings support the development of integrated transitional care and targeted interventions for medical and behavioral health needs to minimize hospital utilization.
Rationale & Objective:
Hospital readmissions represent a significant burden for children with chronic kidney disease (CKD), but the epidemiology and drivers of readmission remain poorly understood. We evaluated 30-day all-cause readmission rates among US pediatric patients with kidney disease and examined associations with clinical and social factors.
Study Design:
Retrospective cohort study.
Setting & Participants:
Children no older than 18 years of age with a diagnosis of CKD discharged from 49 tertiary care centers participating in the Pediatric Health Information System between January 1, 2016, and June 30, 2021.
Predictor:
Primary or comorbid CKD identified using International Statistical Classification of Diseases and Related Health Problems, 10th Revision diagnostic codes.
Outcomes:
All-cause 30-day hospital readmission.
Analytical Approach:
Multivariable logistic regression adjusting for demographic, clinical, and social factors.
Results:
Among 48,228 pediatric patients with CKD (median age, 5.8 years [IQR, 1.0-12.5]; 46.7% female; 50.2% non-Hispanic White), 6,172 (12.8%) were readmitted within 30 days. Among children with kidney failure, 22.3% experienced readmission. In adjusted analyses, higher readmission risk was associated with glomerular CKD etiology (OR, 1.34; 95% CI, 1.23-1.46), complex chronic disease (OR, 6.13; 95% CI, 4.53-8.29), increasing illness severity by All Patient Refined Diagnosis-Related Group (OR, 2.10; 95% CI, 1.84-2.40), longer duration of hospital stay (OR, 1.50; 95% CI, 1.39-1.63), and mental health comorbidity (OR, 1.16; 95% CI, 1.03-1.30). CKD-related index admissions were associated with lower odds of readmission (OR, 0.85; 95% CI, 0.80-0.92). Urban residence was independently associated with readmission (OR, 1.18; 95% CI, 1.08-1.29), whereas insurance type, neighborhood income, and Child Opportunity Index were not.
Limitations:
Laboratory data were not available.
Conclusion:
Approximately 1 in 8 children with CKD and 1 in 5 with kidney failure were readmitted within 30 days. Readmission risk was driven primarily by clinical complexity, illness severity, and mental health comorbidity. These findings inform integrated transitional care strategies and targeted interventions addressing medical and behavioral health needs to reduce preventable hospital use in pediatric CKD.
Plain-Language Summary:
Hospital readmissions place a significant burden on children with chronic kidney disease (CKD) and their families. In the United States, approximately 1 in 8 children with CKD and 1 in 5 children with end-stage kidney disease are readmitted to the hospital within 30 days of discharge. Factors associated with these readmissions remain poorly understood. In this study, we examined hospitalizations of children (age ≤18 years) with CKD across 49 hospitals in the United States to identify factors linked to 30-day readmission. Mental health comorbidities, glomerular cause of CKD, greater illness severity, longer initial hospital stays, and urban residence were associated with higher odds of readmission. Identifying children at higher risk of readmission may help improve discharge planning, follow-up care, and support for families.
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