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Author Notes:

Correspondence: Laura C. Plantinga; laura.plantinga@emory.edu

Authors’ contributions: LP analyzed the data and drafted the manuscript.

LP, JPL, and JMB obtained the data.

LP and BGJ obtained funding for the work.

TM, JPL, and BGJ provided clinical expertise in nephrology.

CMO provided clinical expertise in hospital medicine.

All authors provided critical reviews of the manuscript and read and approved the final manuscript.

Acknowledgements: We thank Marshia Coe and Troy Walker of Health Systems Management, Inc., for assistance with obtaining EMR data and Chad Robichaux, Shailesh Nair, and Andre Bosman of the Emory Department of Medicine Data Analytics and Biostatistics Core for help with data management.

Some of the data reported here have been supplied by the USRDS.

Disclosures: The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the U.S. government.

This work was presented in part at the annual meeting of the American Society of Nephrology, held in New Orleans, Louisiana, October 31- November 5, 2017.

Approval and oversight for this study was provided by the Emory Institutional Review Board (IRB00082448).

Informed consent was waived for this secondary data analysis.

The authors declare that they have no competing interests.


Research Funding:

This project was supported by grant number R03HS025018 from the Agency for Healthcare Research and Quality.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality


  • Science & Technology
  • Life Sciences & Biomedicine
  • Urology & Nephrology
  • Readmission
  • Rehospitalization
  • Pulmonary edema
  • Fluid overload
  • Dialysis
  • ESRD

Post-hospitalization dialysis facility processes of care and hospital readmissions among hemodialysis patients: a retrospective cohort study


Journal Title:

BMC Nephrology


Volume 19, Number 1


, Pages 186-186

Type of Work:

Article | Final Publisher PDF


Background: Both dialysis facilities and hospitals are accountable for 30-day hospital readmissions among U.S. hemodialysis patients. We examined the association of post-hospitalization processes of care at hemodialysis facilities with pulmonary edema-related and other readmissions. Methods: In a retrospective cohort comprised of electronic medical record (EMR) data linked with national registry data, we identified unique patient index admissions (n = 1056; 2/1/10-7/31/15) that were followed by ≥3 in-center hemodialysis sessions within 10 days, among patients treated at 19 Southeastern dialysis facilities. Indicators of processes of care were defined as present vs. absent in the dialysis facility EMR. Readmissions were defined as admissions within 30 days of the index discharge; pulmonary edema-related vs. other readmissions defined by discharge codes for pulmonary edema, fluid overload, and/or congestive heart failure. Multinomial logistic regression to estimate odds ratios (ORs) for pulmonary edema-related and other vs. no readmissions. Results: Overall, 17.7% of patients were readmitted, and 8.0% had pulmonary edema-related readmissions (44.9% of all readmissions). Documentation of the index admission (OR = 2.03, 95% CI 1.07-3.85), congestive heart failure (OR = 1.87, 95% CI 1.07-3.27), and home medications stopped (OR = 1.81, 95% CI 1.08-3.05) or changed (OR = 1.69, 95% CI 1.06-2.70) in the EMR post-hospitalization were all associated with higher risk of pulmonary edema-related vs. no readmission; lower post-dialysis weight (by ≥0.5 kg) after vs. before hospitalization was associated with 40% lower risk (OR = 0.60, 95% CI 0.37-0.96). Conclusions: Our results suggest that some interventions performed at the dialysis facility in the post-hospitalization period may be associated with reduced readmission risk, while others may provide a potential existing means of identifying patients at higher risk for readmissions, to whom such interventions could be efficiently targeted.

Copyright information:

© 2018 The Author(s).

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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