Plantinga LC, et al. - This study entails estimation of the national burden of, and identification of correlates of, readmissions associated with pulmonary edema among hemodialysis patients. Findings reported that hemodialysis patients commonly had readmissions related to pulmonary edema. Overall readmissions could be substantially prevented via preventive interventions, particularly targeted at incident hemodialysis patients with a prior history of heart failure and patients initially admitted for pulmonary edema.

Methods

• Researchers used national registry data in this retrospective cohort study to identify prevalent US hemodialysis patients (n = 215,251) with index admissions while under Medicare primary coverage in 2011–13.
• Admissions occurring within 30 days of the index discharge were defined as readmissions and pulmonary edema-related readmissions were defined as readmissions with discharge diagnoses of fluid overload, heart failure or pulmonary edema.
• In addition, odds ratios (ORs) for pulmonary edema-related readmissions by patient and index admission characteristics were determined using multivariable logistic regression models.

Results

• Findings demonstrated that readmission was reported in about one-quarter (23%) of index hospital admissions, with nearly half (44%) of the readmissions being associated with pulmonary edema.
• A pulmonary edema-related index admission [OR = 2.32; 95% confidence interval (CI) 2.22–2.41] was identified as the strongest independent correlate of pulmonary edema-related readmission.
• In addition, researchers found that with the exception of dialysis vintage <1 year (OR = 1.18; 95% CI 1.14–1.22), chronic obstructive pulmonary disease (OR = 1.34; 95% CI 1.29–1.38), dialysis non-compliance (OR = 1.53; 95% CI 1.41–1.64) and congestive heart failure (OR = 1.85; 95% CI 1.77–1.93), patient characteristics were not generally related to higher risk of pulmonary edema-related readmission.