Reasons For Readmission In Patients With Peritoneal Dialysis

Objectives:Previous research suggests that hospitalization rates and readmission reasons are different in peritoneal dialysis(PD)patients in different regions.However,there is a paucity of studies with large samples examining readmissions in Asia PD patients.Therefore,this study aimed to investigate readmission reasons after peritoneal dialysis catheter implantation.Methods:A total of 864 patients were enrolled,493(57.1%)were male,aged(53.7±15.0)years,and the median dialysis time was 24.4(11.2,42.3)months.The main primary disease was 553 cases(64.1%)of primary glomerulonephritis,followed by 115 cases(15.9%)of diabetic nephropathy,and 357 patients were withdrawn.The main cause of withdrawing was mortality,followed by transfer to hemodialysis.864 PD patients who treat regularly in the First Affiliated Hospital of Nanchang University were enrolled from November 1,2005,to May 1,2018.The patients who were catheterized or follow-up in other hospitals,transferred from permanent HD,failed renal transplantation,or admitted to the first catheter implantation,or age<18 years at the start of PD were excluded in this study.The follow-up cut-off points for all patients were:termination of peritoneal dialysis,mortality,transfer to hemodialysis,transfer to kidney transplant or until May 1,2018.Subgroup analyses were performed based on patients gender and whether with diabetes or not.Kaplan-Meier was used to assess patient readmission rate.P<0.05 was considered as statistically significant.Results:Of the 864 patients with PD,488 had no readmission records,and 376 had readmission records,with a total of 667 hospital admissions.On average,each patient was admitted to the hospital 1.1 per patient-year.The average hospital stay was 12.8 per patient-year.The overall reasons for readmission were mainly inadequate of analysis,peritonitis,cardiovascular diseases and infection.The enrolled patients were divided into two groups according to age,the elderly group(>60 years old)and the non-elderly group(18-60 years old).The results showed that the rehospitalization rate of the elderly group was higher than that of the non-elderly group,and the difference was statistically significant(P<0.001).The main reasons for the readmission of PD patients in our center from 2006 to 2011 was peritonitis,inadequate of dialysis,cardiovascular disease and infection.From 2012 to 2018,inadequate of analysis admitted to hospital beyond peritonitis and became the first reason for readmission of PD patients.The stratified analysis showed that the main reasons for women’s admission were peritonitis,inadequate of dialysis and cardiovascular disease.The main reasons for men’s admission were inadequate of dialysis,peritonitis and cardiovascular disease.The main reasons for admission to patients with diabetic were inadequate of dialysis,cardiovascular disease,and peritonitis.The major reasons for admission to patients without diabetes were inadequate dialysis,peritonitis,and cardiovascular disease.Conclusion:The main reasons for readmission of peritoneal dialysis patients are inadequate dialysis,peritonitis,cardiovascular disease and infection.With the maturity of peritoneal dialysis technology,the proportion of peritonitis has decreased,and the proportion of reasons for inadequate dialysis is relatively high.In addition,gender and Diabetes also effects the reasons for readmission among peritoneal dialysis patients.