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ED Use High Among Patients With End-Stage Renal Disease

August 23, 2016

Adults with newly diagnosed end-stage renal disease (ESRD) are more likely to utilize the emergency department (ED) and had higher rates of hospitalization, according to recent research in JAMA Internal Medicine.

“Patients with end-stage renal disease (ESRD) have the highest risk for hospitalization among those with chronic medical conditions, including heart failure, pulmonary disease, or cancer,” Brendan P. Lovasik, MD, of the department of surgery at the Emory University School of Medicine, and colleagues wrote. “However, to our knowledge, no study has examined use of the emergency department (ED) among the national Medicare population with ESRD. We sought to describe ED visits and hospitalizations through the ED and to determine the sociodemographic and clinical characteristics of patients with ESRD who use ED services in the United States.”

The researcher studied 769,228 adult patients with an ESRD diagnosis between January 1, 2005 and December 31, 2011. Study participants were also covered under either Medicare Part A or Part B insurance. Researchers obtained patient information from the US Renal Data System and Medicare Physician/Supplier and Inpatient databases for Medicare Part A or B claims. Data were analyzed from June 1 to September 30, 2015.

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Study results showed that 535,345 patients (69.6%) had at least one ED visit. Reportedly, over half of the patients (55.0%) with ESRD visited the ED during their first year of diagnosis.

According to the data, the most frequently diagnosed comorbid conditions within in the first ESRD year included, respiratory abnormalities, congestive heart failure, and chest pain. Study results also showed that hyperkalemia and fluid overload, 2 potentially preventable ESRD-related complications, accounted for 131,389 of the 11,061,866 total ED visits.

The researchers found that there were 2,108,915 ED admissions. Furthermore, the most common admission diagnoses were hemodialysis access complication, septicemia, and congestive heart failure during the first ESRD year.

A multivariable analysis showed that factors associated with higher rates of ED use were noted among younger patients, women patients, black patients, patients with comorbid medical conditions, those with Medicaid insurance (vs Medicare alone), patients with catheter or graft hemodialysis access (vs fistula), those who used tobacco, patients who were institutionalized, and those with more recent ESRD diagnoses.

According to the study findings, ESRD patient hospitalization rates are four times higher than the national average.  Although the study’s data was limited to Medicare claims, nearly all patients with ESRD are eligible for Medicare coverage and appropriately reflect a national sample.

The researchers concluded that “focusing on modifiable factors associated with ED use, such as ensuring that patients with chronic kidney disease have early access to nephrology care and placement of fistulas could lead to improved care for patients with ESRD and decreased costs for health systems.” --Julie Gould



Lovasik BP, Zhang R, Hockenberry JM, et al. Emergency Department Use and Hospital Admissions Among Patients With End-Stage Renal Disease in the United States [published online ahead of print August 22, 2016]. JAMA Intern Med. doi: 10.1001/jamainternmed.2016.4975


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