Long-term outcomes among Medicare patients readmitted in the first year of hemodialysis: a retrospective cohort study

BackgroundReadmission within 30days of hospital discharge is common and costly among end-stage renal disease (ESRD) patients. Little is known about long-term outcomes after readmission. We estimated the association between hospital admissions and readmissions in the first year of dialysis and outcomes in the second year.MethodsData on incident dialysis patients with Medicare coverage were obtained from the United States Renal Data System (USRDS). Readmission patterns were summarized as no admissions in the first year of dialysis (Admit-), at least one admission but no readmissions within 30days (Admit+/Readmit-), and admissions with at least one readmission within 30days (Admit+/Readmit+).We used Cox proportional hazards models to estimate the association between readmission pattern and mortality, hospitalization, and kidney transplantation, accounting for demographic and clinical covariates.ResultsAmong the 128,593 Medicare ESRD patients included in the study, 18.5% were Admit+/Readmit+, 30.5% were Admit+/Readmit-, and 51.0% were Admit-. Readmit+/Admit+ patients had substantially higher long-term risk of mortality (HR=3.32 (95% CI, 3.21-3.44)), hospitalization (HR=4.46 (95% CI, 4.36-4.56)), and lower likelihood of kidney transplantation (HR=0.52 (95% CI, 0.44-0.62)) compared to Admit- patients; these associations were stronger than those among Admit+/Readmit- patients.ConclusionsPatients with readmissions in the first year of dialysis were at substantially higher risk of poor outcomes than either patients who had no admissions or patients who had hospital admissions but no readmissions. Identifying strategies to both prevent readmission and mitigate risk among patients who had a readmission may improve outcomes among this substantial, high-risk group of ESRD patients.