Hospital readmission in children on maintenance dialysis: a multicentre, prospective cohort study.

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.