Clinical and Social Risk Factors for 30-Day Readmissions in Children With Kidney Disease.

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.