We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Emergency Department Use Among Adults Receiving Dialysis.
- Authors
Ronksley, Paul E.; Scory, Tayler D.; McRae, Andrew D.; MacRae, Jennifer M.; Manns, Braden J.; Lang, Eddy; Donald, Maoliosa; Hemmelgarn, Brenda R.; Elliott, Meghan J.
- Abstract
This cohort study assesses factors associated with potentially preventable emergency department use by adults receiving maintenance dialysis in Canada. Key Points: Question: What medical and sociodemographic factors are associated with potentially preventable emergency department (ED) use among people receiving maintenance dialysis? Findings: In this cohort study of 4925 adults receiving maintenance dialysis in Alberta, Canada, rates of potentially preventable ED use were higher for individuals aged 44 years or younger and those with chronic pain, greater material deprivation, previous hyperkalemia, and historically high ED use. Meaning: Findings of this study suggest that strategies to mitigate potentially preventable ED use in patients receiving maintenance dialysis should consider individuals' psychosocial and medical factors. Importance: People with kidney failure receiving maintenance dialysis visit the emergency department (ED) 3 times per year on average, which is 3- to 8-fold more often than the general population. Little is known about the factors that contribute to potentially preventable ED use in this population. Objective: To identify the clinical and sociodemographic factors associated with potentially preventable ED use among patients receiving maintenance dialysis. Design, Setting, and Participants: This cohort study used linked administrative health data within the Alberta Kidney Disease Network to identify adults aged 18 years or older receiving maintenance dialysis (ie, hemodialysis or peritoneal dialysis) between April 1, 2010, and March 31, 2019. Patients who had been receiving dialysis for more than 90 days were followed up from cohort entry (defined as dialysis start date plus 90 days) until death, outmigration from the province, receipt of a kidney transplant, or end of study follow-up. The Andersen behavioral model of health services was used as a conceptual framework to identify variables related to health care need, predisposing factors, and enabling factors. Data were analyzed in March 2024. Main Outcomes and Measures: Rates of all-cause ED encounters and potentially preventable ED use associated with 4 kidney disease–specific ambulatory care–sensitive conditions (hyperkalemia, heart failure, volume overload, and malignant hypertension) were calculated. Multivariable negative binomial regression models were used to examine the association between clinical and sociodemographic factors and rates of potentially preventable ED use. Results: The cohort included 4925 adults (mean [SD] age, 60.8 [15.5] years; 3071 males [62.4%]) with kidney failure receiving maintenance hemodialysis (3183 patients) or peritoneal dialysis (1742 patients) who were followed up for a mean (SD) of 2.5 (2.0) years. In all, 3877 patients had 34 029 all-cause ED encounters (3100 [95% CI, 2996-3206] encounters per 1000 person-years). Of these, 755 patients (19.5%) had 1351 potentially preventable ED encounters (114 [95% CI, 105-124] encounters per 1000 person-years). Compared with patients with a nonpreventable ED encounter, patients with a potentially preventable ED encounter were more likely to be in the lowest income quintile (38.8% vs 30.9%; P <.001); to experience heart failure (46.8% vs 39.9%; P =.001), depression (36.6% vs 32.5%; P =.03), and chronic pain (60.1% vs 54.9%; P =.01); and to have a longer duration of dialysis (3.6 vs 2.6 years; P <.001). In multivariable regression analyses, potentially preventable ED use was higher for younger adults (incidence rate ratio [IRR], 1.69 [95% CI, 1.33-2.15] for those aged 18 to 44 years) and patients with chronic pain (IRR, 1.35 [95% CI, 1.14-1.61]), greater material deprivation (IRR, 1.57 [95% CI, 1.16-2.12]), a history of hyperkalemia (IRR, 1.31 [95% CI, 1.09-1.58]), and historically high ED use (ie, ≥3 ED encounters in the prior year; IRR, 1.46 [95% CI, 1.23-1.73). Conclusions and Relevance: In this study of adults receiving maintenance dialysis in Alberta, Canada, among those with ED use, 1 in 5 had a potentially preventable ED encounter; reasons for such encounters were associated with both psychosocial and medical factors. The findings underscore the need for strategies that address social determinants of health to avert potentially preventable ED use in this population.
- Subjects
ALBERTA; MEDICAL care use; KIDNEY failure; PERITONEAL dialysis; HYPERVOLEMIA; RESEARCH funding; CHRONIC pain; HYPERKALEMIA; MULTIPLE regression analysis; QUESTIONNAIRES; SOCIOECONOMIC factors; HOSPITAL emergency services; HEMODIALYSIS; RETROSPECTIVE studies; HEART failure; DESCRIPTIVE statistics; LONGITUDINAL method; CONCEPTUAL structures; SOCIODEMOGRAPHIC factors; CONFIDENCE intervals; MALIGNANT hypertension; COMORBIDITY; DISEASE complications; ADULTS
- Publication
JAMA Network Open, 2024, Vol 7, Issue 5, pe2413754
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.13754