Reasons for admission and predictors of national 30-day readmission rates in patients with end-stage renal disease on peritoneal dialysis.

BACKGROUND

The number of patients with end-stage renal disease (ESRD) on peritoneal dialysis (PD) has increased by over 30% between 2007 and 2014. The Centers for Medicare and Medicaid has identified readmissions in ESRD patients to be a quality measure; however, there is a paucity of studies examining readmissions in PD patients.

METHODS

Utilizing the National Readmission Database for the year 2013, we aimed to determine reasons for admission, the associated rates of unplanned readmission and independent predictors of readmissions in PD patients.

RESULTS

The top 10 reasons for initial hospitalization were implant/PD catheter complications (23.22%), hypertension (5.47%), septicemia (5.18%), diabetes mellitus (DM) (5.12%), complications of surgical procedures/medical care (3.50%), fluid and electrolyte disorders (4.29%), peritonitis (3.76%), congestive heart failure (3.25%), pneumonia (2.90%) and acute myocardial infarction (AMI) (2.01%). The overall 30-day readmission rate was 14.6%, with the highest rates for AMI (21.8%), complications of surgical procedure/medical care (19.6%) and DM (18.4%). Concordance among the top 10 reasons for index admission and readmission was 22.6% and varied by admission diagnosis. Independent predictors of readmissions included age 35-49 years compared with 18-34 years [adjusted odds ratio (aOR) 1.35; 95% confidence interval (CI) 1.09-1.68; P = 0.006], female gender (aOR 1.27; 95% CI 1.12-1.44; P < 0.001), and comorbidities including liver disease (aOR 1.39; 95% CI 1.07-1.81; P = 0.01), peripheral vascular disease (aOR 1.33; 95% CI 1.14-1.56; P < 0.001) and depression (aOR 1.22; 95% CI 1.00-1.48; P = 0.04).

CONCLUSIONS

This study demonstrates the most common reasons for admission and readmissions in PD patients and several comorbidities that are predictive of readmissions. Targeted interventions towards these patients may be of benefit in reducing readmission in this growing population.