Open AccessEarly Hospital Readmission in Older and Younger Kidney Transplant Recipients
Author(s) -
Christine E. Haugen,
Elizabeth A. King,
Sunjae Bae,
Mary G. Bowring,
Courtenay M. Holscher,
Jacqueline Garonzik-Wang,
Mara McAdamsDeMarco,
Dorry L. Segev
Publication year - 2018
Publication title -
american journal of nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.394
H-Index - 85
eISSN - 1421-9670
pISSN - 0250-8095
DOI - 10.1159/000492338
Subject(s) - medicine , hazard ratio , poisson regression , proportional hazards model , dialysis , diabetes mellitus , endocrinology , confidence interval , population , environmental health
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.