Hospital readmission in children on maintenance dialysis: a multicentre, prospective cohort study

Year: 2025

Type: article

Abstract: ABSTRACT Background Limited data exist on rehospitalization in paediatric dialysis patients. The objective of this study was to identify indications, rates and risk factors for 30-day readmissions in this population. Methods We used a prospective multinational, multicentre cohort study of haemodialysis (HD) and peritoneal dialysis (PD) patients discharged between July 2017 and July 2018. Readmission was identified as repeat hospitalization within 30 days of a prior (index) admission. Potentially preventable readmissions were clinically related to the initial admission. Early readmissions were those occurring within 7 days of discharge. The primary outcome was 30-day readmission. Secondary outcomes included potentially avoidable and early readmissions. Results A total of 54 (31%) of 176 patients (102 PD, 74 HD) had at least one readmission; 84 (18%) discharges were followed by readmission. PD and HD patients had similar readmission rates {30.4% versus 31.1%; hazard ratio [HR] 1.06 [95% confidence interval (CI) 0.61–1.81]}. Compared with PD, HD patients had a significantly shorter time to readmission (8 versus 14 days; P = .019), higher early readmission rates (46% versus 18%; P = .010) and risk [odds ratio (OR) 3.87 (95% CI 1.35–11.11)]. Main readmission causes were dialysis access–related non-infectious complications (31%) and access infections (22.7%); 47% of readmissions were potentially avoidable. Lower haemoglobin levels were linked to readmission [HR 0.78 (95% CI 0.64–0.95)]. Bicarbonate use was associated with a 51% lower readmission risk [HR 0.49 (95% CI 0.24–0.99)]. Neurological comorbidity [OR 7.00 (95% CI 1.04–47.22)] and partial recovery [OR 56.45 (95% CI 3.02–1053.10)] were risk factors for avoidable readmission. Risk of avoidable and early readmission decreased with age [OR 0.98 (95% CI 0.97–0.99) and OR 0.99(95%CI 0.98–0.99), respectively]. Conclusions Readmissions are common in paediatric dialysis patients, with a substantial proportion being potentially preventable. To reduce rehospitalizations, interventions should target modifiable factors such as access complications, anaemia and incomplete recovery at discharge, while recognizing non-modifiable risks like HD and younger age to identify high-risk patients.

Source: Clinical Kidney Journal

DOI: 10.1093/ckj/sfaf401

Institutions: Sağlık Bilimleri Üniversitesi, Heidelberg University, Evelina London Children's Healthcare, Great Ormond Street Hospital, Erciyes University, Gazi University, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University Hospital in Motol, Bambino Gesù Children's Hospital, Istituti di Ricovero e Cura a Carattere Scientifico, Aristotle University of Thessaloniki, Gdańsk Medical University, Cukurova University, Polish Mother’s Memorial Hospital Research Institute, Centro Hospitalar do Porto, Hôpitaux Universitaires de Strasbourg, Vilnius University, Ankara University

Language: English

Topic: Dialysis and Renal Disease Management

Subfield: Nephrology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,335

OpenAlex ID: W7116963385