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Shaikh F, Wynne R, L. Castelino R, Inglis SC, Davidson PM, Ferguson C. Direct oral anticoagulant use in hospitalized patients with atrial fibrillation across body mass index categories: design and rationale for a retrospective cohort study. Ther Adv Drug Saf 2024; 15:20420986241227014. [PMID: 38300763 PMCID: PMC10823844 DOI: 10.1177/20420986241227014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024] Open
Abstract
Background Atrial fibrillation (AF) and obesity are common conditions globally; yet, there remains suboptimal pharmacological management contributing to high rates of hospitalization in patients with AF. The altered pathophysiology of both obese and underweight individuals may influence the pharmacology of medications, including those used to manage AF. This, in turn, increases the risk of adverse events and impacts patient risk for stroke and rehospitalization. Despite the well-established complications of obesity, research investigating the relationship between obesity and AF is scant. Objectives The primary aim of this study is to describe cardiovascular-related hospitalization in AF patients according to BMI categories. A secondary aim is to describe anticoagulant and antiarrhythmic prescribing practice patterns in patients with AF, according to the BMI category. Design A retrospective, exploratory descriptive observational cohort study, using routinely collected electronic medical record data from five public hospitals within a single health district, with a population dominantly that is culturally and linguistically diverse, and has a low socioeconomic status. Methods and analysis Data extraction will include a 24-month period (January 2017 to December 2018) with a 12-month follow-up. All adult (⩾18 years) patients at discharge diagnosed with AF, prescribed any oral anticoagulant and/or oral rate/rhythm control agent, will be eligible for inclusion. Ethics and dissemination Ethics approval from the health district and the University of Wollongong has been granted. Findings will seek to demonstrate associations between management strategies and patient outcomes, as well as describe patterns of acute care management from prescribers. These data will be used to inform and generate hypotheses for large-scale studies examining the impact of body weight on anticoagulation prescribing at national and global scales.
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Affiliation(s)
- Fahad Shaikh
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Rochelle Wynne
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Ronald L. Castelino
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Pharmacy Department, Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW, Australia
| | - Sally C. Inglis
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Sydney, NSW, Australia
| | | | - Caleb Ferguson
- Centre for Chronic & Complex Care Research, Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW, Australia
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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Low JK, Crawford K, Lai J, Manias E. Factors associated with readmission in chronic kidney disease: Systematic review and meta-analysis. J Ren Care 2023; 49:229-242. [PMID: 35809061 DOI: 10.1111/jorc.12437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/14/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Risk factors associated with all-cause hospital readmission are poorly characterised in patients with chronic kidney disease. OBJECTIVE A systematic review and meta-analysis were conducted to identify risk factors and protectors of hospital readmission in chronic kidney disease. DESIGN, PARTICIPANTS & MEASUREMENTS Studies involving adult patients were identified from four databases from inception to 31/03/2020. Random-effects meta-analyses were conducted to determine factors associated with all-cause 30-day hospital readmission in general chronic kidney disease, in dialysis and in kidney transplant recipient groups. RESULTS Eighty relevant studies (chronic kidney disease, n = 14 studies; dialysis, n = 34 studies; and transplant, n = 32 studies) were identified. Meta-analysis revealed that in both chronic kidney disease and transplant groups, increasing age in years and days spent at the hospital during the initial stay were associated with a higher risk of 30-day readmission. Other risk factors identified included increasing body mass index (kg/m2 ) in the transplant group, and functional impairment and discharge destination in the dialysis group. Within the chronic kidney disease group, having an outpatient follow-up appointment with a nephrologist within 14 days of discharge was protective against readmission but this was not protective if provided by a primary care provider or a cardiologist. CONCLUSION Risk-reduction interventions that can be implemented include a nephrologist appointment within 14 days of hospital discharge, rehabilitation programme for functional improvement in the dialysis group and meal plans in the transplant group. Future risk analysis should focus on modifiable factors to ensure that strategies can be tested and implemented in those who are more at risk.
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Affiliation(s)
- Jac Kee Low
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
| | - Kimberley Crawford
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Jerry Lai
- eSolution, Deakin University, Geelong, Victoria, Australia
- Intersect Australia, Sydney, New South Wales, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
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Albinali HAH, Singh R, Al Arabi AR, Al Qahtani A, Asaad N, Al Suwaidi J. Predictors of 30-Day Re-admission in Cardiac Patients at Heart Hospital, Qatar. Heart Views 2023; 24:125-135. [PMID: 37584026 PMCID: PMC10424753 DOI: 10.4103/heartviews.heartviews_91_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 05/11/2023] [Indexed: 08/17/2023] Open
Abstract
Background Cardiovascular disease patients are more likely to be readmitted within 30 days of being discharged alive. This causes an enormous burden on health-care systems in terms of poor care of patients and misutilization of resources. Aims and Objective This study aims to find out the risk factors associated with 30-day readmission in cardiac patients at Heart Hospital, Qatar. Methods A total of 10,550 cardiac patients who were discharged alive within 30 days at the heart hospital in Doha, Qatar, from January 2015 and December 2019 were analyzed. The bootstrap method, an internal validation statistical technique, was applied to present representative estimates for the population. Results Out of the 10,550 cardiac patients, there were 8418 (79.8%) index admissions and 2132 (20.2%) re-admitted at least once within 30 days after the index admission. The re-admissions group was older than the index admission group (65.6 ± 13.2 vs. 56.0 ± 13.5, P = 0.001). Multinomial regression analysis showed that females were 30% more likely to be re-admitted than males (adjusted odds ratio [aOR] 1.30, 95% confidence interval [CI]: 1.11-1.50, P = 0.001). Diabetes (aOR 1.36, 95% CI: 1.20-1.53, P = 0.001), chronic renal failure (aOR 1.93, 95% CI: 1.66-2.24, P = 0.001), previous MI (aOR 3.22, 95% CI: 2.85-3.64, P = 0.001), atrial fibrillation (aOR 2.17, 95% C.I. : 1.10-2.67, P = 0.01), cardiomyopathy (aOR 1.72, 95% CI 1.47-2.02, P = 0.001), and chronic heart failure (aOR 1.56, 95% C.I.: 1.33-1.82, P = 0.001) were also independent predictors for re-admission in the regression model. C-statistics showed these variables could predict 82% accurately hospital readmissions within 30 days after being discharged alive. Conclusion The model was more than 80% accurate in predicting 30-day readmission after being discharged alive. The presence of five or more risk factors was found to be crucial for readmissions within 30 days. The study may help design interventions that may result in better outcomes with fewer resources in the population.
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Affiliation(s)
| | - Rajvir Singh
- Department of Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdul Rahman Al Arabi
- Department of Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Awad Al Qahtani
- Department of Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Nidal Asaad
- Department of Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Jassim Al Suwaidi
- Department of Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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4
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Pothuru S, Chan WC, Mehta H, Vindhyal MR, Ranka S, Hu J, Yarlagadda SG, Wiley MA, Hockstad E, Tadros PN, Gupta K. Burden of Hypertensive Crisis in Patients With End-Stage Kidney Disease on Maintenance Dialysis: Insights From United States Renal Data System Database. Hypertension 2023; 80:e59-e67. [PMID: 36752114 DOI: 10.1161/hypertensionaha.122.20546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND There is paucity of information on the incidence, clinical characteristics, admission trends, and outcomes of hypertensive crisis (HTN-C) in patients with end-stage kidney disease (ESKD) who are on maintenance dialysis. METHODS We conducted a retrospective observational study of HTN-C admissions in patients with end-stage kidney disease using the United States Renal Data System. We identified patients with end-stage kidney disease aged ≥18 years on dialysis and were hospitalized for HTN-C from January 2006 to August 2015. RESULTS A total of 54 483 patients with end-stage kidney disease were hospitalized for HTN-C during the study period. After study exclusions, 37 214 patients were included in the analysis. A majority of patients were Black, there were more women than men and the South region of the country accounted for a great majority of patients. During the study period, hospitalization rates increased from 1060 per 100 000 beneficiary years to 1821 (Ptrend<0.0001). Overall, in-hospital mortality, 30-day, and 1-year mortality were 0.6%, 2.3%, and 21.8%, respectively, and 30-day readmission rate was 31.1%. During the study period, most study outcomes showed a significant decreasing trend (in-hospital mortality 0.6%-0.5%, 30-day mortality 2.4%-1.9%, 1-year mortality 23.9%-19.7%, Ptrend<0.0001 for all). CONCLUSIONS Hospitalizations for HTN-C have increased consistently during the decade studied. Although temporal trends showed improving mortality and readmission rates, the absolute rates were still high with 1 in 3 patients readmitted within 30 days and 1 in 5 patients dying within 1 year of index hospitalization.
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Affiliation(s)
- Suveenkrishna Pothuru
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City.,Department of Internal Medicine, Ascension Via Christi Hospital, Manhattan, KS (S.P.)
| | - Wan-Chi Chan
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Harsh Mehta
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Mohinder R Vindhyal
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Sagar Ranka
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Jinxiang Hu
- Department of Biostatistics and Data Science, University of Kansas School of Medicine (J.H.)
| | - Sri G Yarlagadda
- Division of Nephrology and Hypertension, Department of Internal Medicine (S.G.Y.), University of Kansas School of Medicine, Kansas City
| | - Mark A Wiley
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Eric Hockstad
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Peter N Tadros
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Kamal Gupta
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
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Al-Jaishi AA, Jeyakumar N, Kang Y, De Chickera S, Dixon SN, Luo B, Sontrop J, Walsh M, Tonelli M, Garg AX. Health Services Use and Outcomes for Hospital Admissions With a Major Cardiovascular Event Recorded in Health Care Administrative Data in Patients Receiving Maintenance Hemodialysis: A Retrospective Cohort Study. Can J Kidney Health Dis 2023; 10:20543581231165708. [PMID: 37065967 PMCID: PMC10102938 DOI: 10.1177/20543581231165708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/19/2023] [Indexed: 04/18/2023] Open
Abstract
Background Administrative data are used in studies of hemodialysis care to report cardiovascular-related hospitalizations. Showing recorded events are associated with significant health care resource use and poor outcomes would confirm that administrative data algorithms identify clinically meaningful events. Objective The objective of this study was to describe the 30-day health service use and outcomes when a hospital admission with myocardial infarction, congestive heart failure, or ischemic stroke is recorded in administrative databases. Design This is a retrospective review of linked administrative data. Patients and Setting Patients receiving maintenance in-center hemodialysis in Ontario, Canada, between April 1, 2013, and March 31, 2017, were included. Measurements Records from linked health care databases at ICES in Ontario, Canada were considered. We identified hospital admission with the most responsible diagnosis recorded as myocardial infarction, congestive heart failure, or ischemic stroke. We then assessed the frequency of common tests, procedures, consultations, post-discharge outpatient drug prescriptions, and outcomes within 30 days following the hospital admission. Methods We used descriptive statistics to summarize results using counts and percentages for categorical variables and means with standard deviations or medians with quartile ranges for continuous variables. Results There were 14 368 patients who received maintenance hemodialysis between April 1, 2013, and March 31, 2017. The number of events per 1000 person-years was 33.5 for hospital admissions with myocardial infarction, 34.2 for congestive heart failure, and 12.9 for ischemic stroke. The median (25th, 75th percentile) duration of hospital stay was 5 (3-10) days for myocardial infarction, 4 (2-8) days for congestive heart failure, and 9 (4-18) days for ischemic stroke. The chance of death within 30 days was 21% for myocardial infarction, 11% for congestive heart failure, and 19% for ischemic stroke. Limitations Events, procedures, and tests recorded in administrative data can be misclassified compared with medical charts. Conclusions In patients receiving maintenance hemodialysis, hospital admissions of major cardiovascular events routinely recorded in health administrative databases are associated with significant use of health service resources and poor health outcomes.
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Affiliation(s)
- Ahmed A. Al-Jaishi
- Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Lawson Health Research Institute and
London Health Sciences Centre, London, Ontario, Canada
| | | | | | - Sonali De Chickera
- Division of Nephrology, Department of
Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Stephanie N. Dixon
- Lawson Health Research Institute and
London Health Sciences Centre, London, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Medicine, Epidemiology
and Biostatistics, Western University, London, Ontario, Canada
| | - Bin Luo
- ICES, Toronto, Ontario, Canada
| | - Jessica Sontrop
- Lawson Health Research Institute and
London Health Sciences Centre, London, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Michael Walsh
- Departments of Medicine and Health
Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario,
Canada
- Population Health Research Institute,
McMaster University / Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Marcello Tonelli
- Division of Nephrology, Department of
Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amit X. Garg
- Lawson Health Research Institute and
London Health Sciences Centre, London, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of Nephrology, Department of
Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Medicine, Epidemiology
and Biostatistics, Western University, London, Ontario, Canada
- Amit X. Garg, ICES, 800 Commissioners Road
East, ELL-215, London, Ontario, Canada N6A 5W9.
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6
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Mahalingasivam V, Su G, Iwagami M, Davids MR, Wetmore JB, Nitsch D. COVID-19 and kidney disease: insights from epidemiology to inform clinical practice. Nat Rev Nephrol 2022; 18:485-498. [PMID: 35418695 PMCID: PMC9006492 DOI: 10.1038/s41581-022-00570-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 01/08/2023]
Abstract
Over the course of the COVID-19 pandemic, numerous studies have aimed to address the challenges faced by patients with kidney disease and their caregivers. These studies addressed areas of concern such as the high infection and mortality risk of patients on in-centre haemodialysis and transplant recipients. However, the ability to draw meaningful conclusions from these studies has in some instances been challenging, owing to barriers in aspects of usual care, data limitations and problematic methodological practices. In many settings, access to SARS-CoV-2 testing differed substantially between patient groups, whereas the incidence of SARS-CoV-2 infection varied over time and place because of differences in viral prevalence, targeted public health policies and vaccination rates. The absence of baseline kidney function data posed problems in the classification of chronic kidney disease and acute kidney injury in some studies, potentially compromising the generalizability of findings. Study findings also require attentive appraisal in terms of the effects of confounding, collider bias and chance. As this pandemic continues and in the future, the implementation of sustainable and integrated research infrastructure is needed in settings across the world to minimize infection transmission and both prevent and plan for the short-term and long-term complications of infectious diseases. Registries can support the real-world evaluation of vaccines and therapies in patients with advanced kidney disease while enabling monitoring of rare complications.
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Affiliation(s)
- Viyaasan Mahalingasivam
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Guobin Su
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Masao Iwagami
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Department of Health Services Research, University of Tsukuba, Ibaraki, Japan
| | - Mogamat Razeen Davids
- Division of Nephrology, Stellenbosch University, Cape Town, South Africa
- South African Renal Registry, Cape Town, South Africa
- African Renal Registry, African Association of Nephrology, Durban, South Africa
| | - James B Wetmore
- Division of Nephrology, Hennepin Healthcare, Minneapolis, MN, USA
- Chronic Disease Research Group, Hennepin Healthcare, Minneapolis, USA
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
- UK Renal Registry, Bristol, UK.
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Lee CC, Hsu CC, Lin MH, Chen KH, Wu IW. Hospitalization in patients with dialysis in Taiwan: A nationwide population-based observational study. J Formos Med Assoc 2022; 121 Suppl 1:S39-S46. [PMID: 34998659 DOI: 10.1016/j.jfma.2021.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The hospitalization rate is higher in patients with end-stage kidney disease (ESKD) than in the general population. However, the national estimates in Taiwan remain unclear. Therefore, we investigated the hospitalization rates of ESKD patients in a disease-specific manner from 2010 to 2018 in Taiwan. METHODS This population-based study was conducted using data from the National Health Insurance Research Database. We analyzed the hospitalization rates of patients with ESKD, defined as continuous dialysis for at least three successive months. The first diagnosis at discharge for each hospitalization was defined as the main diagnosis of hospitalization. The hospitalization rate in a certain year was calculated as the number of hospitalizations divided by the number of patients undergoing chronic dialysis in the respective year. RESULTS Hospitalization occurred in half of all prevalent ESKD patients, with an increasing trend over time. The hospitalization rate increased from 964.1 per 1000 person-years in 2010 to 1037.9 per 1000 person-years in 2018. ESKD patients who were male, aged over 75 years, and receiving hemodialysis had higher hospitalization rates. Infection-related hospitalization was the main cause of hospitalization, followed by cardiovascular disease. The 30-day re-admission rate was 19%, and the in-hospital mortality rate was 9%. CONCLUSION Hospitalization rates continued to increase from 2010 to 2018. The high hospitalization rates for infection-related diseases and hemodialysis patients call for further strategies to be developed that reduce the hospitalization burden.
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Affiliation(s)
- Chin-Chan Lee
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Ming-Huang Lin
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Kuan-Hsing Chen
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - I-Wen Wu
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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8
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Li J, Huang N, Zhong Z, Joe P, Wang D, Ai Z, Wu L, Jiang L, Huang F. Risk factors and outcomes of cardiovascular disease readmission within the first year after dialysis in peritoneal dialysis patients. Ren Fail 2021; 43:159-167. [PMID: 33441045 PMCID: PMC7808740 DOI: 10.1080/0886022x.2020.1866009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background In the first year of dialysis, patients are vulnerable to cardiovascular disease (CVD) hospitalization, but knowledge regarding the risk factors and long-term outcomes of cardiovascular readmission within the first year after dialysis in incident continuous ambulatory peritoneal dialysis (CAPD) patients is limited. Methods This retrospective cohort study was conducted in incident CAPD patients. The demographic characteristics, laboratory parameters, and CVD readmission were collected and analyzed. The primary outcome was all-cause mortality, and the secondary outcomes included CVD mortality, infection-related mortality and technique failure. A logistic regression was used to identify the risk factors associated with CVD readmission within the first year after dialysis. Cox proportional hazards models were used to evaluate the association between CVD readmission and the outcomes. Results In total, 1589 peritoneal dialysis (PD) patients were included in this study, of whom 120 (7.6%) patients had at least one episode of CVD readmission within the first year after dialysis initiation. Advanced age, CVD history, and a lower level of serum albumin were independently associated with CVD readmission. CVD readmission within the first year after dialysis was significantly associated with all-cause (HR 2.66, 95%CI 1.91–3.70, p < 0.001) and CVD (HR 3.42, 95%CI 2.20–5.31, p < 0.001) mortality, but not infection-related mortality or technique failure, after adjusting for confounders. Conclusions Our findings suggest that an advanced age, a history of CVD, and a lower level of serum albumin were independently associated with CVD readmission. Moreover, CVD readmission was associated with all-cause and cardiovascular mortality in incident CAPD patients.
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Affiliation(s)
- Jianbo Li
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Naya Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Zhong Zhong
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Pema Joe
- Department of Medicine, Linzhi People's Hospital, Linzhi, China
| | - Dan Wang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Zhen Ai
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Lisha Wu
- Department of Medicine, Linzhi People's Hospital, Linzhi, China
| | - Lanping Jiang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Fengxian Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
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9
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Chen R, Yang C, Zhu M, Chu H, Wang J, Gao B, Liu L, Jiang Y, Lin Y, Wu J, Kong G, Wang F, Zhang L, Zhao M. Association of cardiovascular disease with 30-day hospital readmission in Chinese patients receiving maintenance dialysis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:617. [PMID: 33987315 PMCID: PMC8106029 DOI: 10.21037/atm-20-2367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Previous studies have shown cardiovascular disease (CVD) to be a risk factor in the prediction of 30-day hospital readmission among patients receiving dialysis. However, studies of Asian populations are limited. In the present study, we examined the association between CVD and 30-day hospital readmission in Chinese patients receiving maintenance dialysis. Methods Patients receiving maintenance dialysis were identified by searching a national claims database, the China Health Insurance Research Association (CHIRA) database, using the International Classification of Diseases revision 10 (ICD-10) and items of medical service claims. Patients aged ≥18 years who were discharged after index hospitalization between January 2015 and December 2015 were included in our retrospective analysis. CVD-related diagnoses were divided into three categories: coronary heart disease (CHD), heart failure (HF), and stroke. Thirty-day hospital readmission was defined as any hospital readmission within the 30 days following discharge. Logistic regression models adjusted for logit of propensity scores (PS) were used to assess the association of CVD with 30-day hospital readmission. Results Of 4,700 patients receiving dialysis, the 30-day hospital readmission rate was 10.4%. Compared with patients without CVD, there was an increased risk of 30-day hospital readmission among maintenance dialysis patients with total CVD [odds ratio (OR): 1.33, 95% confidence interval (CI): 1.06–1.66]. Patients with HF (OR: 1.77, CI: 1.27–2.47) and stroke (OR: 2.14, 95% CI: 1.53–2.98) had a greater risk of 30-day hospital readmission. The fully adjusted OR of CHD for the risk of 30-day hospital readmission was 1.22 (95% CI: 0.97–1.55). Conclusions CVDs, especially stroke and HF, are independent predictors of 30-day hospital readmission in Chinese patients receiving dialysis, and could help to guide interventions to improve the quality of care for these patients.
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Affiliation(s)
- Rui Chen
- Department of Medicine, Peking University First Hospital, Beijing, China
| | - Chao Yang
- Department of Medicine, Peking University First Hospital, Beijing, China
| | - Ming Zhu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Hong Chu
- Department of Medicine, Peking University First Hospital, Beijing, China
| | - Jinwei Wang
- Department of Medicine, Peking University First Hospital, Beijing, China
| | - Bixia Gao
- Department of Medicine, Peking University First Hospital, Beijing, China
| | - Lili Liu
- Department of Medicine, Peking University First Hospital, Beijing, China
| | - Yifang Jiang
- Department of Medicine, Peking University First Hospital, Beijing, China
| | - Yu Lin
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jingyi Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Guilan Kong
- National Institute of Health Data Science at Peking University, Beijing, China.,Center for Data Science in Health and Medicine, Peking University, Beijing, China
| | - Fang Wang
- Department of Medicine, Peking University First Hospital, Beijing, China
| | - Luxia Zhang
- Department of Medicine, Peking University First Hospital, Beijing, China.,National Institute of Health Data Science at Peking University, Beijing, China.,Center for Data Science in Health and Medicine, Peking University, Beijing, China
| | - Minghui Zhao
- Department of Medicine, Peking University First Hospital, Beijing, China.,Peking-Tsinghua Center for Life Science, Beijing, China
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10
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Doshi S, Wish JB. Strategies to Reduce Rehospitalization in Patients with CKD and Kidney Failure. Clin J Am Soc Nephrol 2021; 16:328-334. [PMID: 32660962 PMCID: PMC7863646 DOI: 10.2215/cjn.02300220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Readmissions in patients with nondialysis-dependent CKD and kidney failure are common and are associated with significant morbidity, mortality, and economic consequences. In 2013, the Centers for Medicare and Medicaid Services implemented the Hospital Readmissions Reduction Program in an attempt to reduce high hospitalization-associated costs. Up to 50% of all readmissions are deemed avoidable and present an opportunity for intervention. We describe factors that are specific to the patient, the index hospitalization, and underlying conditions that help identify the "high-risk" patient. Early follow-up care, developing volume management strategies, optimizing nutrition, obtaining palliative care consultations for seriously ill patients during hospitalization and conducting goals-of-care discussions with them, instituting systematic advance care planning during outpatient visits to avoid unwanted hospitalizations and intensive treatment at the end of life, and developing protocols for patients with incident or prevalent cardiovascular conditions may help prevent avoidable readmissions in patients with kidney disease.
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Affiliation(s)
- Simit Doshi
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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11
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Scheuch M, Freiin von Rheinbaben S, Kabisch A, Engeßer J, Ahrendt S, Dabers T, Kohler C, Holtfreter S, Bröker BM, Stracke S. Staphylococcus aureus colonization in hemodialysis patients: a prospective 25 months observational study. BMC Nephrol 2019; 20:153. [PMID: 31060511 PMCID: PMC6503363 DOI: 10.1186/s12882-019-1332-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/12/2019] [Indexed: 12/24/2022] Open
Abstract
Background Dialysis patients are frequently exposed to Staphylococcus aureus due to stays in dialysis centers, hospitals or rest homes. The hemodialysis vascular access is a potential entry site for S. aureus, in particular when using a central venous catheter (CVC) which increases the risk of sepsis compared to arteriovenous (AV) fistula. We prospectively followed a cohort of 86 hemodialysis patients from an outpatient dialysis center over 25 months analyzing S. aureus carrier status, S. aureus infection rates and mortality. Methods Demographic data and patients´ medical histories were collected and followed from all hemodialysis patients. Blood samples, nasal swabs and swabs from the hemodialysis vascular access site were taken every six months for a period of 25 months and tested for S. aureus. Strains were cultured and further characterized by spa PCR and microarray-based genotyping. Resulting data were compared with those from the general population. Results In cross-sectional analyses, an average of 40% of hemodialysis patients were S. aureus carriers compared to 27% in the general population. Longitudinally, a total of 65% were S. aureus carriers: 16% were persistent carriers, 43% were intermittently colonized. The most common S. aureus lineage in the dialysis patient cohort was the clonal complex (CC) 8 and the spa type t008, while in the general population, the clonal complex CC30 dominates. During the study period, we observed six S. aureus-associated blood stream infections with one S. aureus attributable death. S. aureus carriers with an AV fistula were more densely colonized in the nasal mucosa compared to patients with a CVC. Overall mortality was lower for hemodialysis patients with a positive S. aureus carrier status compared to non-carriers (hazard ratio of 0.19). Conclusions Compared to the general population, hemodialysis patients were more frequently colonized with S. aureus and displayed both different S. aureus colonization densities as well as lineages, possibly explained by more frequent exposure to health care environments. The lower overall mortality in carriers compared to non-carriers is intriguing and will be investigated in detail in the future. Trial registration ISRCTN 14385893, 2. October 2018, retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12882-019-1332-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthias Scheuch
- Department of Internal Medicine A, Division of Nephrology, University Medicine Greifswald, Greifswald, Germany
| | | | - Antje Kabisch
- Department of Internal Medicine A, Division of Nephrology, University Medicine Greifswald, Greifswald, Germany
| | - Jonas Engeßer
- Department of Internal Medicine A, Division of Nephrology, University Medicine Greifswald, Greifswald, Germany
| | - Susanne Ahrendt
- Kuratorium für Dialyse und Nierentransplantation e.V., KfH-Nierenzentrum Greifswald, Greifswald, Germany
| | - Thomas Dabers
- Department of Internal Medicine A, Division of Nephrology, University Medicine Greifswald, Greifswald, Germany.,Kuratorium für Dialyse und Nierentransplantation e.V., KfH-Nierenzentrum Greifswald, Greifswald, Germany
| | - Christian Kohler
- Institute of Medical Microbiology, University Medicine Greifswald, Greifswald, Germany
| | - Silva Holtfreter
- Institute of Immunology and Transfusion Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Barbara M Bröker
- Institute of Immunology and Transfusion Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Sylvia Stracke
- Department of Internal Medicine A, Division of Nephrology, University Medicine Greifswald, Greifswald, Germany. .,Kuratorium für Dialyse und Nierentransplantation e.V., KfH-Nierenzentrum Greifswald, Greifswald, Germany.
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12
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Abougergi MS, Peluso H, Saltzman JR. Thirty-Day Readmission Among Patients With Non-Variceal Upper Gastrointestinal Hemorrhage and Effects on Outcomes. Gastroenterology 2018; 155:38-46.e1. [PMID: 29601829 DOI: 10.1053/j.gastro.2018.03.033] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/13/2018] [Accepted: 03/19/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We aimed to determine the rate of hospital readmission within 30 days of non-variceal upper gastrointestinal hemorrhage and its impact on mortality, morbidity, and health care use in the United States. METHODS We performed a retrospective study using the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project Nationwide Readmission Database for the year 2014 (data on 14.9 million hospital stays at 2048 hospitals in 22 states). We collected data on hospital readmissions of 203,220 adults who were hospitalized for urgent non-variceal upper gastrointestinal hemorrhage and discharged. The primary outcome was rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity (shock and prolonged mechanical ventilation) and resource use (length of stay and total hospitalization costs and charges). Independent risk factors for readmission were identified using Cox regression analysis. RESULTS The 30-day rate of readmission was 13%. Only 18% of readmissions were due to recurrent non-variceal upper gastrointestinal bleeding. The rate of death among patients readmitted to the hospital (4.7%) was higher than that for index admissions (1.9%) (P < .01). A higher proportion of readmitted patients had morbidities requiring prolonged mechanical ventilation (1.5%) compared with index admissions (0.8%) (P < .01). A total of 133,368 hospital days was associated with readmission, and the total health care in-hospital economic burden was $30.3 million (in costs) and $108 million (in charges). Independent predictors of readmission were Medicaid insurance, higher Charlson comorbidity score, lower income, residence in a metropolitan area, hemorrhagic shock, and longer stays in the hospital. Older age, private or no insurance, upper endoscopy, and prolonged mechanical ventilation were associated with lower odds for readmission. CONCLUSIONS In a retrospective study of patients hospitalized for non-variceal upper gastrointestinal hemorrhage, 13% are readmitted to the hospital within 30 days of discharge. Readmission is associated with higher mortality, morbidity, and resource use. Most readmissions are not for recurrent gastrointestinal bleeding.
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Affiliation(s)
- Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, South Carolina; Catalyst Medical Consulting, Simpsonville, South Carolina
| | - Heather Peluso
- Department of General Surgery, University of South Carolina Greenville Memorial Hospital, Greenville, South Carolina
| | - John R Saltzman
- Director of Endoscopy, Division of Gastroenterology, Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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