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Dialysis patients are known to have greater rates of hospitalization as compared to other patients. The cause for this is believed to be multifactorial. The present study by Chan et. al. looks at possible factors which may reduces the rate of hospitalization of dialysis patients after an initial admission.
The population studied was quite large with over 126,000 dialysis patients involved. The premise of the study was that the management strategy at the time of first discharge was a significant contributor to the time to readmission of the patient. The Primary outcome of the investigation was therefore readmission of the patient within 30 days.
Based on the abstract the study can be summarized as follows:
Compared to pre-hospitalization values, the levels of hemoglobin, albumin, phosphorus, calcium, and parathyroid hormone and weight were significantly decreased after hospitalization.
Using statistical models, those patients whose hemoglobin was monitored within the first 7 days after discharge, followed by modification of their erythropoietin dose had a significantly reduced risk for repeat-hospitalization when compared to the patients whose hemoglobin was not checked, nor was the dose of erythropoietin changed.
Similarly, administration of vitamin D within 7 days following discharge was significantly associated with reduced repeat hospitalization when compared to patients on no vitamin D.
Therefore, it appears that immediate re-evaluation of anemia management orders and resumption of vitamin D soon after discharge may be an effective way to reduce repeat hospitalization.
What can we take home from this study?
Hospitalization results in alteration of levels of important electrolytes and molecules important to the pathophysiology of renal disease. The diagnosis or reason for admission may have a significant impact in this respect and hence the specific management of the patient post admission should vary greatly.
It is interesting that by simply focusing on management of anemia and vitamin D metabolism one is capable of reducing re-hospitalization in patients across the board regardless of diagnosis or reason for admission.
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