Understanding Readmission Risks in End-Stage Kidney Disease: A Study from Wangaya Hospital
Abstract
Background: End-stage kidney disease (ESKD) is a growing health burden. Poor patient knowledge and treatment adherence contribute to increased morbidity, as reflected in readmission rates.
Objective: This study aimed to identify factors associated with readmission among ESKD patients in Bali.
Methods: A retrospective cohort study was conducted at Wangaya Hospital. Adult patients (≥18 years) diagnosed with ESKD, with or without dialysis, between 2022 and 2024 were included. Patients with incomplete records or a solitary kidney were excluded. Bivariate analysis (chi-square test) and multivariate analysis (binary logistic regression) were used to assess associations, with significance set at p <0.05.
Results: A total of 199 patients met the inclusion criteria; 61.8% were male, with a median age of 57 years (range: 22–88 years). Readmission rates within and beyond one month were 18.6% and 15.1%, respectively. Reduced eGFR was significantly associated with 30-day readmission (p = 0.041). For readmission beyond 30 days, significant predictors included diabetes mellitus (p = 0.014), neurologic disorders (p < 0.001), and adherence (p = 0.019).
Conclusion: eGFR predicts early readmission, while diabetes mellitus, neurological disorders, and treatment adherence influence later readmissions. Identifying these factors is vital for improving patient education and reducing healthcare burdens.
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References
2. Organisation KI. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013;3(1):1.
3. Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS. Global Prevalence of Chronic Kidney Disease – A Systematic Review and Meta-Analysis. PLoS One. 2016;11(7):e0158765. doi:10.1371/journal.pone.0158765
4. Evans M, Lewis RD, Morgan AR, Whyte MB, Hanif W, Bain SC. A Narrative Review of Chronic Kidney Disease in Clinical Practice: Current Challenges and Future Perspectives. Adv Ther. 2022;39(1):33–43. doi:10.1007/s12325-021-01927-z
5. Luyckx VA, Tonelli M, Stanifer JW. The global burden of kidney disease and the sustainable development goals. Bull World Heal Organ. 2018;96(6):414–422D. doi:10.2471/blt.17.206441
6. Thomas R, Kanso A, Sedor JR. Chronic Kidney Disease and Its Complications. Prim Care. 2008;35(2):329–44. doi:10.1016/j.pop.2008.01.008
7. Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B. Chronic kidney disease: global dimension and perspectives. Lancet. 2013;382(9888):260–72. doi:10.1016/s0140-6736(13)60687-x
8. Go AS, Chertow GM, Fan D, McCulloch CE, Yuan HC. Chronic Kidney Disease and the Risks of Death, Cardiovascular Events, and Hospitalization. N Engl J Med. 2004;351(13):1296–305. doi:10.1056/nejmoa041031
9. Plantinga LC, Tuot DS, Powe NR. Awareness of Chronic Kidney Disease Among Patients and Providers. Adv Chronic Kidney Dis. 2010;17(3):225–36. doi:10.1053/j.ackd.2010.03.002
10. Tuot DS, Wong KK, Velasquez A, Crews DC, Zonderman AB, Evans MK. CKD Awareness in the General Population: Performance of CKD-Specific Questions. Kidney Med. 2019;1(2):43–50. doi:10.1016/j.xkme.2019.01.005
11. Wijayanti S, Pujiarto P, Dewi AR. Hubungan Kepatuhan Hemodialisis dengan Interdialytic Weight Gain (IDWG) Pada Pasien Hemodialisis. MAHESA Malahayati Heal Student J. 2024;4(2):475–84. doi:10.33024/mahesa.v4i2.13148
12. Wagle A, Sigdel MR. Factors Affecting Readmission in Hospitalized Patients with Chronic Kidney Disease: a Single Center Study. J Inst Med Nepal. 2022;44(2):14–21. doi:10.59779/jiomnepal.1217
13. Surasura A, Siva Krishna Pavan Kumar BG, Chinamanagonda S, Durga D, Gubbala S. Understanding Hospital Readmissions: Insights, Patterns, and Interventions for Improvement in Chronic Kidney Disease. Cureus. 2024;16(5):e59524. doi:10.7759/cureus.59524
14. Xie Y, Bowe B, Xian H, Balasubramanian S, Al-Aly Z. Rate of Kidney Function Decline and Risk of Hospitalizations in Stage 3A CKD. Clin J Am Soc Nephrol. 2015;10(11):1946–55. doi:10.2215/cjn.04480415
15. Dhondup T, Qian Q. Electrolyte and acid-base disorders in chronic kidney disease and end-stage kidney failure. Blood Purif. 2017;43(1–3):179–188. doi:10.1159/000452725
16. Alicic RZ, Rooney MT, Tuttle KR. Diabetic Kidney Disease: Challenges, Progress, and Possibilities. Clin J Am Soc Nephrol. 2017;12(12):2032–45. doi:10.2215/cjn.11491116
17. Hickson LJ, Thorsteinsdottir B, Ramar P, Reinalda MS, Crowson CS, Williams AW, et al. Hospital Readmission among New Dialysis Patients Associated with Young Age and Poor Functional Status. Nephron. 2018;139(1):1–12. doi:10.1159/000485985
18. Feigin VL, Roth GA, Naghavi M, Parmar P, Krishnamurthi R, Chugh S. Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol. 2016;15(9):913–924. doi:10.1016/s1474-4422(16)30073-4
19. Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet. 2011;377(9778):1693–1702. doi:10.1016/s0140-6736(11)60325-5
20. Kumar V, Abbas AK, Aster JC. Robbins and Cotran Pathologic Basis of Disease. 10th ed. Elsevier; 2020.
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