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Charlson Comorbidity Index score may help predict hospital readmission for patients on dialysis
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Among patients who received maintenance dialysis, those who had higher Charlson Comorbidity Index scores were more likely to have unplanned 30-day hospital readmissions than those with lower scores, according to a published study.
“Previous studies revealed that multiple comorbidities were associated with the risk of 30-day readmission for maintenance hemodialysis patients, though it is difficult to quantitatively or semi-quantitatively use those results in clinical practice for risk-stratification,” Yu Lin, of Peking University in Beijing, and colleagues wrote. “In the field of nephrology, Charlson Comorbidity Index (CCI) has been used to predict mortality in patients with acute kidney injury and diabetic kidney disease. As for patients with ESKD, several studies have validated that the CCI was an effective tool for comorbidity assessment and it could be used for survival prediction. To the best of our knowledge, there are few studies investigating the association between CCI and 30-day readmission in hemodialysis and peritoneal dialysis patients.”
Using the Hospital Quality Monitoring System — a national administrative database in China — researchers identified 124,721 patients on dialysis who were hospitalized between January 2013 and December 2015. The primary outcome of the study was unplanned hospital readmission within 30 days of discharge (planned/unplanned were documented in the database through the question: “Is there any plan to readmit the patient?”).
Researchers found 16% of the study population had an unplanned readmission, with risk increasing with higher CCI score. Compared with those without comorbidity (a CCI score of 2, scored for dialysis), hazard ratios for patients with CCI 3 to 4, 5 to 6 or more than 6 were 1.01, 1.09 and 1.14, respectively. The readmission rate was higher among patients on PD compared with those on hemodialysis.
The study also noted the 30-day readmission rate for patients with kidney disease varied among different countries (35.4% in United States vs. 17% in Canada). Researchers suggested this may be due to differences in the pattern of dialysis services and patients’ characteristics.
“Although varied, high readmission rates among the ESKD population were common and imposed increased burdens on health systems,” they wrote. “Our study indicated that CCI was a predictor for the risk of 30-day readmission and could be used for clinical risk prediction and patient management. For hospitalized dialysis patients with a CCI of 5 or higher, relatively intense follow-up is needed, especially during the first month after discharge.” – by Melissa J. Webb
Disclosures: Lin reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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