The American journal of emergency medicine · 2025
Predictors of missed hemodialysis in end-stage renal disease patients presenting to the emergency department.
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Payette Christopher, Heidish Ryan, Loganathan Aditya, Lagunzad Isabella, Wang Haoling, Bolden Taylor, Loganathan Tarun, Shahamatdar Soroush, Bagchi Pramita, Wilder Marcee, Barshay Meylakh, Ma Yan, Meltzer Andrew C
Аннотация
OBJECTIVES: Patients with end-stage renal disease (ESRD) often present to the emergency department (ED) after missing hemodialysis (HD) sessions, but it is unclear how these patients differ from those who are adherent. We compared ED patients with ESRD who recently missed HD versus those adherent to identify associated risk factors, and we explored differences in 12-month ED revisits.
METHODS: We prospectively enrolled adult ED patients with ESRD on HD at a single urban academic ED and classified them as "HD-Missed" (≥1 missed session in the prior week) or "HD-Adherent." Participants completed a biopsychosocial survey, and ED course data were collected. A retrospective chart review assessed acute care utilization at 12 months.
RESULTS: Among 129 enrolled patients, 66 were HD-Missed and 63 were HD-Adherent. Compared with adherent patients, HD-Missed patients were more likely to have prior ED visits for HD (58 % vs 37 %, p = 0.03), present with severe electrolyte abnormalities (30 % vs 6 %, p = 0.001), report ≥30-min travel times to dialysis (30 % vs 8 %, p = 0.004), and have multiple missed HD sessions in the prior month (43 % vs 17 %, p = 0.005). At 12 months, HD-Missed patients had numerically higher ED revisits, although this difference did not reach statistical significance.
CONCLUSIONS: ED patients with ESRD who miss HD exhibit distinct clinical and social risk factors compared with adherent patients. Addressing modifiable barriers such as transportation and competing priorities may improve HD adherence and reduce acute care utilization.
METHODS: We prospectively enrolled adult ED patients with ESRD on HD at a single urban academic ED and classified them as "HD-Missed" (≥1 missed session in the prior week) or "HD-Adherent." Participants completed a biopsychosocial survey, and ED course data were collected. A retrospective chart review assessed acute care utilization at 12 months.
RESULTS: Among 129 enrolled patients, 66 were HD-Missed and 63 were HD-Adherent. Compared with adherent patients, HD-Missed patients were more likely to have prior ED visits for HD (58 % vs 37 %, p = 0.03), present with severe electrolyte abnormalities (30 % vs 6 %, p = 0.001), report ≥30-min travel times to dialysis (30 % vs 8 %, p = 0.004), and have multiple missed HD sessions in the prior month (43 % vs 17 %, p = 0.005). At 12 months, HD-Missed patients had numerically higher ED revisits, although this difference did not reach statistical significance.
CONCLUSIONS: ED patients with ESRD who miss HD exhibit distinct clinical and social risk factors compared with adherent patients. Addressing modifiable barriers such as transportation and competing priorities may improve HD adherence and reduce acute care utilization.