Early Hospital Readmission in Older and Younger Kidney Transplant Recipients

Christine E. Haugen, Elizabeth King, Sunjae Bae, Mary Grace Bowring, Courtenay M. Holscher, Jacqueline Garonzik, Mara Ann McAdams Demarco, Dorry Segev

Research output: Contribution to journalArticle

Abstract

Background: Up to 31% of kidney transplant (KT) recipients experience early hospital readmission (EHR). We hypothesized that EHR among older KT recipients is higher than younger recipients due to increased comorbidities and higher prevalence of frailty. Methods: We identified 22,458 older (age ≥65) and 86,372 younger (18 to < 65) first-time KT recipients (December 1, 1999 - December 31, 2014) using United States Renal Data System data. We estimated the association between patient-level characteristics and EHR (30 days post-KT discharge) with modified Poisson regression among older and younger KT recipients, separately. We estimated the association between graft loss and mortality and EHR using Cox proportional hazards. Results: EHR was more common in older KT recipients (30.1 vs. 27.6%; p < 0.001). Risk factors for EHR that differed by recipient age included female sex, African American race, diabetes, smoking, dialysis vintage, donor age, and length of stay. Risk of graft loss associated with EHR was greater among older KT recipients (adjusted hazard ratio [aHR] 1.64, 95% CI 1.51-1.77, p < 0.001) than younger KT recipients (aHR 1.43, 95% CI 1.38-1.48, p < 0.001; interaction p < 0.01). However, the risk of mortality associated with EHR was greater among younger recipients (aHR 1.52, 95% CI 1.47-1.57, p < 0.001) than that in older -recipients (aHR 1.40, 95% CI 1.34-1.47, p < 0.001; interaction p < 0.01). Conclusions: Older KT recipients are more likely to experience EHR and are at a higher risk of graft loss after EHR than younger recipients. Targeted interventions to prevent EHR and subsequent graft loss in this population should be identified.

Original languageEnglish (US)
Pages (from-to)235-241
Number of pages7
JournalAmerican Journal of Nephrology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Patient Readmission
Kidney
Transplants
Transplant Recipients
Mortality
Information Systems
African Americans
Comorbidity
Dialysis
Length of Stay
Smoking
Tissue Donors

ASJC Scopus subject areas

  • Nephrology

Cite this

Early Hospital Readmission in Older and Younger Kidney Transplant Recipients. / Haugen, Christine E.; King, Elizabeth; Bae, Sunjae; Bowring, Mary Grace; Holscher, Courtenay M.; Garonzik, Jacqueline; McAdams Demarco, Mara Ann; Segev, Dorry.

In: American Journal of Nephrology, 01.01.2018, p. 235-241.

Research output: Contribution to journalArticle

@article{f80e32a9c9754222995d3fc48fc5bc97,
title = "Early Hospital Readmission in Older and Younger Kidney Transplant Recipients",
abstract = "Background: Up to 31{\%} of kidney transplant (KT) recipients experience early hospital readmission (EHR). We hypothesized that EHR among older KT recipients is higher than younger recipients due to increased comorbidities and higher prevalence of frailty. Methods: We identified 22,458 older (age ≥65) and 86,372 younger (18 to < 65) first-time KT recipients (December 1, 1999 - December 31, 2014) using United States Renal Data System data. We estimated the association between patient-level characteristics and EHR (30 days post-KT discharge) with modified Poisson regression among older and younger KT recipients, separately. We estimated the association between graft loss and mortality and EHR using Cox proportional hazards. Results: EHR was more common in older KT recipients (30.1 vs. 27.6{\%}; p < 0.001). Risk factors for EHR that differed by recipient age included female sex, African American race, diabetes, smoking, dialysis vintage, donor age, and length of stay. Risk of graft loss associated with EHR was greater among older KT recipients (adjusted hazard ratio [aHR] 1.64, 95{\%} CI 1.51-1.77, p < 0.001) than younger KT recipients (aHR 1.43, 95{\%} CI 1.38-1.48, p < 0.001; interaction p < 0.01). However, the risk of mortality associated with EHR was greater among younger recipients (aHR 1.52, 95{\%} CI 1.47-1.57, p < 0.001) than that in older -recipients (aHR 1.40, 95{\%} CI 1.34-1.47, p < 0.001; interaction p < 0.01). Conclusions: Older KT recipients are more likely to experience EHR and are at a higher risk of graft loss after EHR than younger recipients. Targeted interventions to prevent EHR and subsequent graft loss in this population should be identified.",
author = "Haugen, {Christine E.} and Elizabeth King and Sunjae Bae and Bowring, {Mary Grace} and Holscher, {Courtenay M.} and Jacqueline Garonzik and {McAdams Demarco}, {Mara Ann} and Dorry Segev",
year = "2018",
month = "1",
day = "1",
doi = "10.1159/000492338",
language = "English (US)",
pages = "235--241",
journal = "American Journal of Nephrology",
issn = "0250-8095",
publisher = "S. Karger AG",

}

TY - JOUR

T1 - Early Hospital Readmission in Older and Younger Kidney Transplant Recipients

AU - Haugen, Christine E.

AU - King, Elizabeth

AU - Bae, Sunjae

AU - Bowring, Mary Grace

AU - Holscher, Courtenay M.

AU - Garonzik, Jacqueline

AU - McAdams Demarco, Mara Ann

AU - Segev, Dorry

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Up to 31% of kidney transplant (KT) recipients experience early hospital readmission (EHR). We hypothesized that EHR among older KT recipients is higher than younger recipients due to increased comorbidities and higher prevalence of frailty. Methods: We identified 22,458 older (age ≥65) and 86,372 younger (18 to < 65) first-time KT recipients (December 1, 1999 - December 31, 2014) using United States Renal Data System data. We estimated the association between patient-level characteristics and EHR (30 days post-KT discharge) with modified Poisson regression among older and younger KT recipients, separately. We estimated the association between graft loss and mortality and EHR using Cox proportional hazards. Results: EHR was more common in older KT recipients (30.1 vs. 27.6%; p < 0.001). Risk factors for EHR that differed by recipient age included female sex, African American race, diabetes, smoking, dialysis vintage, donor age, and length of stay. Risk of graft loss associated with EHR was greater among older KT recipients (adjusted hazard ratio [aHR] 1.64, 95% CI 1.51-1.77, p < 0.001) than younger KT recipients (aHR 1.43, 95% CI 1.38-1.48, p < 0.001; interaction p < 0.01). However, the risk of mortality associated with EHR was greater among younger recipients (aHR 1.52, 95% CI 1.47-1.57, p < 0.001) than that in older -recipients (aHR 1.40, 95% CI 1.34-1.47, p < 0.001; interaction p < 0.01). Conclusions: Older KT recipients are more likely to experience EHR and are at a higher risk of graft loss after EHR than younger recipients. Targeted interventions to prevent EHR and subsequent graft loss in this population should be identified.

AB - Background: Up to 31% of kidney transplant (KT) recipients experience early hospital readmission (EHR). We hypothesized that EHR among older KT recipients is higher than younger recipients due to increased comorbidities and higher prevalence of frailty. Methods: We identified 22,458 older (age ≥65) and 86,372 younger (18 to < 65) first-time KT recipients (December 1, 1999 - December 31, 2014) using United States Renal Data System data. We estimated the association between patient-level characteristics and EHR (30 days post-KT discharge) with modified Poisson regression among older and younger KT recipients, separately. We estimated the association between graft loss and mortality and EHR using Cox proportional hazards. Results: EHR was more common in older KT recipients (30.1 vs. 27.6%; p < 0.001). Risk factors for EHR that differed by recipient age included female sex, African American race, diabetes, smoking, dialysis vintage, donor age, and length of stay. Risk of graft loss associated with EHR was greater among older KT recipients (adjusted hazard ratio [aHR] 1.64, 95% CI 1.51-1.77, p < 0.001) than younger KT recipients (aHR 1.43, 95% CI 1.38-1.48, p < 0.001; interaction p < 0.01). However, the risk of mortality associated with EHR was greater among younger recipients (aHR 1.52, 95% CI 1.47-1.57, p < 0.001) than that in older -recipients (aHR 1.40, 95% CI 1.34-1.47, p < 0.001; interaction p < 0.01). Conclusions: Older KT recipients are more likely to experience EHR and are at a higher risk of graft loss after EHR than younger recipients. Targeted interventions to prevent EHR and subsequent graft loss in this population should be identified.

UR - http://www.scopus.com/inward/record.url?scp=85053773183&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85053773183&partnerID=8YFLogxK

U2 - 10.1159/000492338

DO - 10.1159/000492338

M3 - Article

SP - 235

EP - 241

JO - American Journal of Nephrology

JF - American Journal of Nephrology

SN - 0250-8095

ER -