Journal article
Measures of Global Health Status on Dialysis Signal Early Rehospitalization Risk after Kidney Transplantation
PloS one, v 11(6), pp e0156532-e0156532
2016
PMID: 27257680
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Early rehospitalization (<30 days) after discharge from kidney transplantation (KT) is associated with poor outcomes. We explored summary metrics of pre-transplant health status that may improve the identification of KT recipients at risk for early rehospitalization and mortality after transplant.
We performed a retrospective cohort study of 8,870 adult (≥ 18 years) patients on hemodialysis who received KT between 2000 and 2010 at United States transplant centers. We linked Medicare data to United Network for Organ Sharing data and data from a national dialysis provider to examine pre-KT (1) Elixhauser Comorbidity Index, (2) physical function (PF) measured by the Short Form 36 Health Survey, and (3) the number of hospitalizations during the 12 months before KT as potential predictors of early rehospitalization after KT. We also explored whether these metrics are confounders of the known association between early rehospitalization and post-transplant mortality.
The median age was 52 years (interquartile range [IQR] 41, 60) and 63% were male. 29% were rehospitalized in <30 days, and 20% died during a median follow-up time of five years (IQR 3.6-6.5). In a multivariable logistic model, kidney recipients with more pre-KT Elixhauser comorbidities (adjusted odds ratio [aOR] 1.09 per comorbidity, 95% Confidence Interval [CI] 1.07-1.11), the poorest pre-KT PF (aOR 1.24, 95% CI 1.08-1.43), or >1 pre-KT hospitalizations (aOR 1.32, 95% CI 1.17-1.49) were more likely to be rehospitalized. All three health status metrics and early rehospitalization were independently associated with post-KT mortality in a multivariable Cox model (adjusted hazard ratio for rehospitalization: 1.41, 95% CI 1.28-1.56).
Pre-transplant metrics of health status, measured by dialysis providers or administrative data, are independently associated with early rehospitalization and mortality risk after KT. Transplant providers may consider utilizing metrics of pre-KT global health status as early signals of vulnerability when transitioning care after KT.
Metrics
Details
- Title
- Measures of Global Health Status on Dialysis Signal Early Rehospitalization Risk after Kidney Transplantation
- Creators
- Meera N Harhay - Drexel UniversityAlexander S Hill - Children's Hospital of PhiladelphiaWei Wang - Kaiser PermanenteOrit Even-Shoshan - Children's Hospital of PhiladelphiaAdam S Mussell - University of PennsylvaniaRoy D Bloom - University of PennsylvaniaHarold I Feldman - University of PennsylvaniaJason H Karlawish - University of PennsylvaniaJeffrey H Silber - Children's Hospital of PhiladelphiaPeter P Reese - University of Pennsylvania
- Publication Details
- PloS one, v 11(6), pp e0156532-e0156532
- Publisher
- Public LIbrary of Science (PLOS)
- Grant note
- K23 DK105207 / NIDDK NIH HHS F32 DK096758 / NIDDK NIH HHS R01 DK090388 / NIDDK NIH HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:000377369700075
- Scopus ID
- 2-s2.0-84973463361
- Other Identifier
- 991019335238604721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Urology & Nephrology