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Author Notes:

Correspondence: laura.plantinga@emory.edu

Katherine H. Ross and Bernard G. Jaar contributed equally to this work.

Research idea and study design: BJ, LP; data acquisition: RP, LP; data analysis/interpretation: KR, BJ, LP; manuscript drafting: KR, LP, BJ; editing and revising: KR, BJ, LP, TM, JL, RP; supervision: LP.

All authors have read and approved the final version of the manuscript.

Two authors are affiliated with BMC Nephrology (Bernard Jaar, Section Editor; Laura Plantinga, Associate Editor); neither had any role in the handling or peer review of this manuscript.


Research Funding:

Support for this work was provided by the Agency for Healthcare Research and Quality (R03 HS025018–01).


  • Science & Technology
  • Life Sciences & Biomedicine
  • Urology & Nephrology
  • Hemodialysis
  • Hospital readmissions
  • Mortality
  • Morbidity
  • Kidney transplantation

Long-term outcomes among Medicare patients readmitted in the first year of hemodialysis: a retrospective cohort study


Journal Title:

BMC Nephrology


Volume 20, Number 1


, Pages 285-285

Type of Work:

Article | Final Publisher PDF


BACKGROUND: Readmission within 30 days of hospital discharge is common and costly among end-stage renal disease (ESRD) patients. Little is known about long-term outcomes after readmission. We estimated the association between hospital admissions and readmissions in the first year of dialysis and outcomes in the second year. METHODS: Data on incident dialysis patients with Medicare coverage were obtained from the United States Renal Data System (USRDS). Readmission patterns were summarized as no admissions in the first year of dialysis (Admit-), at least one admission but no readmissions within 30 days (Admit+/Readmit-), and admissions with at least one readmission within 30 days (Admit+/Readmit+).We used Cox proportional hazards models to estimate the association between readmission pattern and mortality, hospitalization, and kidney transplantation, accounting for demographic and clinical covariates. RESULTS: Among the 128,593 Medicare ESRD patients included in the study, 18.5% were Admit+/Readmit+, 30.5% were Admit+/Readmit-, and 51.0% were Admit-. Readmit+/Admit+ patients had substantially higher long-term risk of mortality (HR = 3.32 (95% CI, 3.21-3.44)), hospitalization (HR = 4.46 (95% CI, 4.36-4.56)), and lower likelihood of kidney transplantation (HR = 0.52 (95% CI, 0.44-0.62)) compared to Admit- patients; these associations were stronger than those among Admit+/Readmit- patients. CONCLUSIONS: Patients with readmissions in the first year of dialysis were at substantially higher risk of poor outcomes than either patients who had no admissions or patients who had hospital admissions but no readmissions. Identifying strategies to both prevent readmission and mitigate risk among patients who had a readmission may improve outcomes among this substantial, high-risk group of ESRD patients.

Copyright information:

© The Author(s). 2019

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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